© 2011 Estate ol Pálilo Pinasso/An! sts Rights Society IARSI. Now York At the age of 91, shortly before his death, Picasso painted this remarkable self-portrait. He faces his death with eyes wide open no pretenses, some fear, some wonder. CHAPTER ELDERHOOD (75 UNTIL DEATH) 14 CASE STUDY fredhale, supercentenarian Fred Hale was bom December 1, 1890 in New Sharon, Maine. His biography and photo portrait are included in a book on "supercen-tenarians,"people who have lived to be 110 or more. Earth's Elders: The Wisdom of the World's Oldest People, by Jerry Friedman. Perhaps the most amusing story from Fred came about when he was 107 and still living on his own. At that age, he was the world's oldest licensed driver. There had been a heavy snowfall in Maine and Fred was up on his porch roof shoveling off the snow. When he finished, he hopped off into a snow bank and then went into his house to change his wet clothes. Suddenly he noticed there were flashing lights outside. When he opened the door, there were the firemen and police who'd come to his rescue. When he was told that a passerby had seen someone fall of the roof, Fred quipped, "I didn't fall, I jumped" and slammed the door. Fred has been confined to a wheelchair and the assisted care facility after he tripped and broke his hip. That hasn't dulled I lis mind however. He still jokes and plays cards with his son of eighty. He read a little and loved to watch the Red Sox. clearly, he was the oldest Red Sox fan in the world. When asked why tie had lived so long he jibed, "Oh, I don't know, punishment I guess. I've enjoyed all my years, each one. I even like the recent one." The last time we spoke I asked, "If there was one piece of wisdom you'd like to pass on to your grandchildren what would it be?" "You have one life to live, live it well, and don't disgrace your fan lily." Source: Jerry Friedman, 2005, p. 80. case study: Fred Hale, Supercentenarian The Longevity Revolution Secrets to Longevity The Gender Gap Among the Very Old A New Psychosocial Stage: Elderhood Developmental Tasks Coping with the Physical Changes of Aging Developing a Psychohistorical Perspective Traveling Uncharted Territory: Life Structures in Elderhood case study: Mr. z The Psychosocial Crisis: immortality Versus Extinction Immortality Extinction The Central Process: Social Support The Benefits of Social Support The Dynamics of Social Support The Social Support Network The Prime Adaptive Ego Quality and the Core Pathology Confidence Diffidence Applied Topic: Meeting the Needs of the Frail Elderly Defining Frailty Supporting Optimal Functioning The Role of the Community The Role of Creative Action Chapter Summary Key Terms 567 568 j chapter 14 Elderhood (75 Until Death) i- Explain the rationale for identifying elderhood as a unique developmental stage for those of unusual longevity with its own developmental tasks and psychosocial crisis. 2. List the physical changes associated with aging, and evaluate the challenges that these changes pose for continued psychosocial well-being. j. Describe the concept of an altered perspective on time and history that emerges among the long-lived. 4. Summarize elements of the lifestyle structure in elderhood, especially living arrangements and gender roles, and analyze the impact of these life structures for continued well-being. 5. Define and explain the psychosocial crisis of immortality versus extinction, the central process of social support, the prime adaptive ego quality of confidence, and the core pathology of diffidence. 6. Apply research and theory to concerns about meeting the needs of the frail elderly. CASE ANALYSIS Using What You Know 1. Summarize your assumptions about the lifestyle and be- l aviors of elders. I low does this case confirm or disconfirm those assumptions? 2. List five of Fred's personality characteristics. Explain how these qualities may contribute to longevity. 3. Analyze Fred's final wisdom. What are the implications of this advice for you and your family? For others in your generation? PABLO PICASSO, WHOSE works illustrate this book, lived lo be 91 years old. When he was 79, he married Jacqueline Roque with whom he enjoyed 12 years ol married lile. During the last 20 years otitis life, he remained productive and energetic, persistently experimenting with new art forms and ideas. Here are some other examples of people who achieved maji ir accomplishments after the age of 80 (Wallechinsky &r Wallace, 199 '.; Wallechinsky, Wallace, & Wallace, 1977): At 100, (irandma Moses was still painting. At ')'), iwin sisters Kin Narila and Gin Kanie recorded a hit ' single in |apan and tailed in a television commercial. At 'H,' ieorgc Burns, who won an I )scar at age 80 lor his role in /lie Sunshine liny,, performed at Proctors Theater in Schenectady, Hew York., 63 years after he had first played there. Ai 95, < Ieorgc Bernard Shaw wrote the play Farfetched Fables. Ai 91, hamuli de Valera served as president ol Ireland, Ai 91 , llulda ( .rook i climbed Mount Whitney, the high ■ ■ .1 mountain in die ■ oniiiicninl I Jnitecl Stales. Ai 89, Arthur Rubenstein gave one of his greatest piano i1 ■' Hal. in New York's Carnegie I kill. Al 88, Konrad Adenauer was chancellor of Germany. Ai 87, Mary Baker Eddy founded the Christian Science Monitor. Ai 81, Benjamin Franklin provided leadership lor the political compromises that led to the adoption ol the U.S. ( ^institution. The Longevity Revolution We are entering a period in which increasing numbers of people are living into old age. As the previous examples illustrate, it's not that we have no models of the long-lived in earlier periods of history, but that so many more adults are living into iheirHOsand 90s than ever before. In 2010, 6% of the U.S. population was 75 and older, and as the baby boomers (those born between 1946 and 1964) mature, this age group is expected to reach I 1% of the population. In L980, more than 2 million people were 85 and older; by 2010, this group had grown to 5.5 million. Of these, 53,364 were 100 years and older. The 85-and-older population, which is the fastest-growing age group in the United States, is expected to reach 6.6 million in 2020 (Werner, 201 1). The 2:0th century was unique in human history in the large percentage of people who lived well beyond their reproductive and childrearing years into later adulthood and elderhood. This new facet of life raises questions about the pattern of mortality alter achieving reproductive success and about what, if any, limit there might be to the human life span. Current projections suggest that in the United States the average life expectancy al birth will be 80 by the year 2020 (U.S. Census Bureau, 20l0i). Genetically based diseases that emerge only in the second half ol Hie, such as breast and colon cancer oi adult-onset diabetes, become more common as larger numbers of people reach advanced age. At the same lime, the mapping of the human genome along with medical and technical innovations hold lite promise ol preventing some ol the diseases now associated with later lile. Life expectancy is most influenced by interventions that prevent infants and children from dying, ensuring that more people will reach advanced ages of 70 or older. Interventions that influence the lile expectancy al ages 70 and older, however, will increase overall life expectancy by only a lew years. Nonetheless, significant discoveries that might prevent death fhe Longevity Revolution j 569 from cancers or cardiovascular diseases could affect large populations and continue to extend human longevity. From an evolutionary perspective, the human species is a highly complex organism designed to survive over a relatively long period in order to find a male, reproduce, and rear and nurture the young until they are old enough to reproduce. The adaptive value of life after this sequence is not well understood. One hypothesis is that the extended family— composed ol grandparents as well as parents—provides more resources for the support of the young and forms an added protective layer against crises that might leave llie younger generation vulnerable (Baudisch & Vaupel, 2012). It is clear that there is a genetic basis to longevity. Studies of centenarians (people 100 years old and over) find that there is a relatively large number of genetic markers involving over 1 30 genes that predict extreme longevity. These markers become increasingly accurate in predicting which individuals will live to advanced ages of 100 and older. Studies ol these centenarians find three different patterns of resilience that are associated with longevity. One group has many of the same diseases of aging before age 80 as those who are not so long lived, but they recover and continue on to advanced age. One group has delayed age-related illness after the age of 80. And one group had no age-related illnesses even al age 100. Genetic factors contribute to the compression of illness toward the very end of life and enhanced capacities for recovery (Anderson, Sebas-lien, et al., 2012; Sebastian, Solovieff, DeWan, el al, 2012). Each new cohort of the very old will benefit from the information and technologies that are being developed. The more knowledge is gained about the biological processes of aging and the genetic basis of diseases and health that emerge in later life, the more likely it is thai human longevity can be extended. Those adults in the current baby boom generation (born between 1946 and 1064) are quite likely to be high school graduates, to have benefited from man)' of the health-related innovations of the late 20th and early 2 1st centuries and to be even more vigorous than our current older population. The projections ol increased numbers of people reaching advanced age are due to increases in longevity due to Improvements in health care and fitness and to the size of the baby boom cohort. Secrets to Longevity The very long lived, like Jeanne Calment (Figure 14.1), inspire others to ask about the factors thai contribute to a long life. Jim Ilcynen (1990) interviewed 100 people who were 100 years or older. He found wide variations in their life-Styles and philosophical perspectives. Some ol the advice they offered on how to live a long life follows: "Mind your own business, have a good cigar, and take a shot of brandy." Brother Adelard Beaudet, Harrisville, Rhode Island "I've lived long because I was so mean." Pearl Rom-baeh, Melbourne, Florida figure 14.1 Jeanne Calment, who died in 1997 at the age of 122, was the world's longest living person whose birth date could be verified. Mine. Calment liked chocolates, smoked cigarettes, and had a wonderful sense of humor. Here she displays her Guinness certificate acknowledging her record-winning longevity. "I always walked several miles a day. I'd talk to the flowers." Mary Frances Annand, Pasadena, California "Don't smoke before noon. Don'l drink or smoke after midnight. The body needs 12 hours of the day to clear itself." Harry Wander, Boise, Idaho "I've been a tofu eater till my life; a mild, gentle man, never a worrier." Frank Morimilsu, Chicago, Illinois "\ picked my ancestors carefully.'" Stella H. Hams, Manhattan, Kansas Regular hours, taking it easy, smiling, whistling at the women when they walk by."John Hilton, Fort Lauderdale, Florida A team ol nutritionists, psychologists, physicians, and gerontologists interviewed 12 Cuban men and women who were reported to be more than 100 years old about their daily diets and lifestyles. The one theme they all agreed upon was the importance ol an optimistic outlook on life. The coordinator of the meeting, Dr. Eugenio Selman, said thai lite six basic elements to longevity are (1) motivation to live, (2) appropriate diet, (3) medical attention, (4) intense physical activity, (5) cultural activities, and (6) a healthy environment. In "his analysis, one sees the interaction of the biological, psychological, and societal systems (CNN.com, 2005). Surprisingly abseni from this list is the role of social integration and social support. A growing literature highlights the contribution ol a sense ol belonging to overall health and resilience in the lace ol crisis (Gow et al., 2007). 570 j chapter 14 blderhood (75 Until Death) The Gender Gap Among the very Old A discussion of aging in the United States must acknowledge the shilling sex composition of the population at older ages. In 2010, 60% of those 75-84 were women, 70% of those 85-94 were women, and 80% of those 95 and older were women (Werner, 201 I). This gender gap in longevity is observed in virtually all countries of the world, but the differences are accentuated in the developed countries. The imbalance in the sex composition is much more noticeable today than it was 50 years ago when there were about as many men as women in the older-than-65 category. Because ihose currently at the stage of elderhood arc predominantly women, many of the social issues of aging—especially poverty, health care, the future of social security, and housing— are also viewed as women's issues. further REFLECTION: The majority of the elderly arc women. Generate some implications of this jar social policy and community development. A New Psychosocial Stage: Elderhood ••••> OBJECTIVE 1, Explain the rationale for identifying elderhood as a unique developmental stage for those of unusual longevity with its own developmental tasks and psychosocial. The lacl thai an increasing number of people are reaching advanced year'; and that they share certain personal and behavioral characteristics leads us to hypothesize a new stage ol psychosocial development thai emerges ai ihe upper end of the life span after one has exceeded ihe life expectancy lor one's birth cohort. This is the stage hie thai is experienced by the long-lived in a commu-nil) who have outlived mosl of their age-males. Drawing on ihr concepi ol village elders who share their wisdom and help resolve community disputes, we call this stage elderhood. Although ii was not specifically identified in Inl .on, original formulation of life stages, Erikson began i'' characterize the dynamics of psychosocial adaptation in litis period ol life in du book Vital Involvement in Old Age Mail".on el ab, 1986). Throughoul this chapter, we have drawn on Erikson's insights to enrich our appreciation of ihe courage, vitality, and transformations that accompany elderhood. We have lormulaled a psychosocial analysis ol development in elderhood based on research literature, firsthand reports, and personal observations to describe ihe developmental tasks, psychosocial crisis, central process, prime adaptive ego quality, and core pathology of this stage. We approach this formulation ol a new stage realizing that in many domains—especially physical functioning, reaction lime, memories, and cognitive abilities—variability increases significantly with age. With advanced age, a person is less constrained by pressures ol institutionalized roles and social demands. As a result, personal preferences and genetically based sources of individuality are freer to be expressed (Figure 14.2). In addition, individual differences reflect ihe diversity of educational experiences, health or illness, exposure to harsh conditions, and patterns ol work and family life. figure 14.2 Former U.S. President Jimmy Carter cont cues to function in an informal role as a diplomat and advocate of peaceful solutions to world problems. In 2002 he was awarded the Nobel peace prize. Here he is at age 88 coming to the West Bank town of Ramallah to nicer with the president of the Palestinian Authority. In 1982 he established the Carter center, focusing on efforts to resolve conflict, promote democracy, protect human rights, and prevent disease. The center has spearheaded the international effort to eradicate Guinea worm disease whicn is poised to be the second human disease in history to be eradicated. Developmental Tasks | 571 The concept of norm of reaction introduced in chapter 4 ("The Period of Pregnancy and Prenatal Development) oilers a framework lor understanding die enormous variability in vitality and functioning during elderhood. The quality of functioning in elderhood is a product of the interaction between genetic factors, lifestyle choices, and environmental supports. Genetic factors influence longevity, vulnerability to illnesses, intelligence, and personality factors that contribute to coping (Pollack, 2001). Support lor a genetic basis to longevity is provided from observations from the New England Centenarian Study that found thai hall the centenarians had grandparents, siblings, and other close relatives who also reached very advanced ages (Perls, Kunkel, & Puea, 2002). Lifestyle factors include physical activity, diet, control over ones life, smoking, alcohol and drug use, and the quality of ones social network. Environmental conditions include poverty, discrimination, social alienation, and lack of social support. Data comparing the life expectancy across countries suggest that environmental conditions, including air and water quality, health care services, housing, and educational resources, all contribute to longevity beyond what die individual person can control (Katch, 20 13). Variations in life experiences and outlook among the very old are great. As a result, chronological age becomes less useful as an indicator of aging. Neugarten (1981) offered a distinction that helps clarify the functional differences among the very old. She described two groups: the old-old and the young-old. The old-old have "suffered major physical or mental decrements" which increase their dependence on health and social services. 'Phis group will grow as the number ol adults over 75 increases. Currently, it forms a minority ol the very old. The majority of people over 75 can be described as young-old. They are competent, vigorous, and relatively healthy. I hey live in their own households and participate in activities in their communities. Lor example, among the New England centenarians studied, 90% were functionally independent and relatively healthy up until age 92 (Perls &r "ferry, 2007). Our intention is to discuss some of the most salient characteristics of life alter age 75 and to articulate what appears to be a psychosocial crisis specific to this period. We report evidence of common challenges and successful strategies for coping amid the great diversity ol individual experiences. further reflection: Evaluate the argument that it is necessary to introduce a new stave of elderhood '» the tile-span perspective. What evidence supports the need to differentiate elderhood from the stage of later adulthood? Developmental Tasks Despite the wide variability in capacities, lifestyles, and worldviews in later life, three themes characterize the challenges that lace individuals in elderhood. hirst, the)' must adapt to physical changes, monitoring their health and modi-lying their lifestyles to accommodate these changes. Second, they must conceptualize their lives within a new time frame, realigning their thoughts about past, present, and future in order to stay connected to the present in a meaningful way. Third, they must develop new life structures—especially living arrangements and social relationships—that provide comfort, interest, and appropriate levels of care. Coping with the Physical Changes of Aging ••••> OBJECTIVE 2. List the physical changes associated with aging, and evaluate the challenges that these changes pose for continued psychosocial well-being. There is no way to avoid the realization that with advanced age ones body is not what it used to be. Erikson described it as follows: With aging, as the overall tonus ol the bod)' begins to sag and innumerable inner parts call attention to themselves through their malfunction, ihe aging body is forced into a new sense ol invalidness. Some problems may be fairly petty, like the almost inevitable appearance of wrinkles. Others are painful, debilitating, and shaming. Whatever the severity of these ailments, the elder is obliged to turn attention from more interesting aspects ol lile to the demanding requirements of the body. This can lie frustrating and depressing. (Erikson el ah, 1980, p. 509) Aging, which is a continuous process over die life span, includes both development and decline. In later lile, some physical changes are considered to he normal oi expected, and not especially related to disease. People who are well educated, have access io health care and other resources, and have observed healthy lifestyle practices in earlier stages ol lile arc still going io experience some of the normative changes of aging when they reach advanced age, such as some loss ol muscle strength or difficulty return ing to normal respiration alter periods of exertion. I lowever, certain lifestyle practice-, including smoking cigarettes, alcohol and drug abuse, poor diet, ami a sedentary lile are likely to accelerate these patterns oi normal decline. Other changes are disease related and not a result of normal aging. Some genetic factors appear to increase vulnerability to these diseases, but so do lifestyle factors, exposure to toxins, and stress. I hus, we want to emphasize that die physical changes ol aging arc multidimensional and variable across individuals. Some people who have observed a healthy lifestyle in earl) and middle adulthood still experience diseases whereas others who have led a more risk)' lifestyle do not experience these diseases. We do not lull)' understand the extent to which genetic, environmental, social, and lifestyle factors help support continued health or vulnerability to disease in elderhood. 572 chapter 14 Elderhood (75 Until Death) The theme of the physical changes of aging can be approached much like its counterpart in early adolescence. Although the rate of change may be slower, older adults notice changes in a wide range of areas, including appearance, body shape, strength and stamina, and the accumulation of chronic illnesses. Just as in adolescence, the rale and sequence of changes vary from person to person. This section will identify major areas of physical change. The patterns of change described here are average trends. Not all adults experience all of these changes, nor to the same degree. Important issues include the meaning that adults attribute to their physical condition and the coping strategies they invent to adapt to these changes. Most of us know older adults who are vigorous and zest-lul. On the other hand, we also know older adults who are painfully limited in their ability to function because of physical disabilities. Many factors influence the progression of physical changes associated with aging, not the least ol which is the level of fitness thai was established and maintained during early and middle adulthood. The topics of fitness, sleep and rest, behavioral slowing, sensory changes, health, illness, and functional independence combine to provide a picture of the physical changes of aging. ranges ir, posture can cause an older person to (eel light- ■ of bodily Fitness There is a great deal of variation m fitness among people alter age 75 as patterns of activity or inactivity, endurance or frailty, and illness or health lake their toll. What is described here might be thought of as the usual patterns of aging. However, these changes are not inevitable and, in many instances, are reversible or modifiable with appropriate intervention (Dobek, White, & Gunter, 2007). What arc the elements ol physical fitness that are typically assessed in older populations? Seven components arc often included in measures intended to assess fitness among the el derly: coordination, reaction time, balance, muscle strength, muscle endurance, llexibilily, and cardiorespiratory endurance (I filgenkamp, van Wijck, & Evenhuis, 2010). Among those 75 and older, elders who exhibit high levels ol fitness an- also likely to report a better overall quality of life, higher cognitive functii ining, lower levels ol depression, and a lower likelihood "I encountering physical disabilities as they age ( lainaka, Takizawa, Katamoto, & Aoki, 200'-); Takata el al. 2010; Voelker Rehage,' lodde, & Staudinger, 2010). Mosl people begin to notice declines in their physical health and lit in- ;; in their late 20s and early 30s. As those who love baseball arc likely to claim, "The legs are the first 'o go." < )n a more positive note, mosl people's strength and capacity for moderate effort are about the same at age 70 as they were at age 40 (Slevens-I.oiig & Commons, 1992). I lowcver, older people are less resilient alter a period of prolonged exertion. Trie respiratory and circulatory systems usually degenerate to some extent and are less capable of providing the heart and muscle tissue with oxygenated blood as quickly as they once could. One result is that sudden k"*d. In order to T C8U5e an older Pcrs™ I •fange, an older no, SUCCessf"% to this kind oih s,owLv and to chan7°n ''nd " necessary to move more servabfe change mfh P°SUions more deliberately. This ob-Tffy interpreted as p.temP0 movement may be incor-often a Purposeful st °' Weakness when, in fact, it is Slowed metabolism f preven£ing dizziness, are new risks Blood CS lhe nccd for Tories, bl" 3nd b°dy fat increa ^ kvds are llkclY 10 rise after eating lyPc 2 diabetes »1 T ' Se editions increase the risk of e,lmJnation offo„(( !°n food intake—particularly the essentia] vitarnins J fch ^ milk—may result in the lack ol resullingmalnulrj, jo mintrak in a" oldti persons die:. The "°n deficiencies J i'"^ l,lc" c°ntribute to osteoporosis ana 3nd a 'ack o/re.SJiien' ',roc,Ucc fedin8» "'weakness, fatigue. lUcces^unywkh ce Mesgeset al., 2001). In order to cope **** more cori-T Cd aPPetitc-a very old person must tflc nL't'HionaI elerne l°US seIecting,oods that mil provide , Many health rn C'llS necessafy for healthy functioning. b£en attributed to iT™* °f Iater adulthood that may have °r indirect result J ,8'"g Process 'tselfare in fact a direct f09- a period1 of! 'mhlmm™- In the years from 2007 to itates, researchers ec°nomic downturn in the United Se,curi'ty among J?°md substantial increases in food in-ad,I,lh°od as t: ,"tS deluding those in middle and W* F»od inspf! 35 eWerhood (Ziliak and Gunderson. 'ntake. fewer calonU{ '"s assoc^ed with lower nutritional 8rC''Ue,,il A ttuSu ,ai,ty and in need ol more health level Z ° fect0rs makc * difficult to maintain/ tha 1 1 e,ySf'Cal fitness «n later life. Some aspects of as ce l!'n nCSS 3re 3 result °f 1 he body's natural pjj prod e Pl'aUE and again and, through «*»b££ ^£ °dUCtS thal ^ harmful to the bo£* °f choices anT?°fagingthm reduC£ fitneSS ^liS^ Posure t CaVy 111 fats, too much time in the sun, Comm;nVlr0nn'Cn!al t0xins. and lack of health - ument to physical fitness is important for ^ , '"ent idem fi Cp°n Healthy People 2020, the U.S. g'' n PhySiai' 3Cti^ as a kKV fel°r U1 Prl3 Hum n t rVen!ing ^ss (U.S. Department of action T5' °' ^ A P™ary goal is to «n*«^ ,J;"ly Uhv 3Chieve thJs goal is to encourage AS , ^cJS*Ctbrily T«e recommended level ol ate aerlv d6S:2 hours and 30 minutes a week ol ^ «nd balanl UVlty; strengthening activities 2 days a 3). ^'^-^ihesBdaysoiwriorcaweekCf^14 Developmental Tasks | 573 PSRE 14.3 Those who survive into their 90s demonstrate sur 13n§ good health, solly has been bowling since he was JO. at age o aphe,stil1 ^joys the sport and carries a 123 average in the 80 and Kr league. ^Rular physical activity is associated with decreasec a ^th from heart disease, lower risk of diabetes^ >Ion J*', and prevention of high blood pressure. I hysicaTac > "bo improves muscle and bone strength .contribute5 ° W*ght control, and improves strength, Flexibly, and W , Ce ,These latter factors all reduce chances ol senOU injury Crchy Preserving functional independence. Despite tl tages, 55% of those ages 75 and older do not engage any iei er ih HevZ7 leisure timc physical activity, ani f. 87% say thai they °rHealth c v'S°rous P^ysica] activity (National Center ^ithad tiCS,2010)-Se<^etUai-C Vanc'n8 agc, sonic people lend to become more '° '"aim, ' 'ose interesl in physical aciiviiy. In order er;Uive J',"1 "P'bnal functioning and to retard the degen-fi3w, r. ec£s of aging, very old adults must sense of well-being (Ades, Bailor, Ashikaga, Ution, ep- haVe | Cls 01 aKipg' vcry ° is for physical ex- e * Suent and regular opportunityJor p>J ^ enhance cardiovascular ff^^lt (nearer c 01 'he effects of a sedentary ^duU_^even among Sorne JeWeight,or"resistance7training fIt,ws ,^'-y "Id, a steady P^^lSnd ™ Stre*gth, which contributes to agiW) ing at about the same time each day and waking themselves up after about hall an hour had a greater sense of self-efficacy and less experience ol sluggishness in the afternoon and evening (Kaida et al., 2006). The relationship of napping to well-being is noi fully understood. People who are able to nap during the day may also be in greater control of their lives and less exposed to stress. On the other hand, taking a nap may be a deliberate way to reduce stress, relax, and prepare to engage more fully in the remaining hours ol the day. Not surprising, napping several times a day is associated with unusual feelings of sleepiness during the day, depression, and pain (Pole)' et al., 2007). 574 j chapter 14 Eldorhood (75 Until Death) Behavioral Slowing One of the most commonly noted markers of aging is a gradual slowing in response to stimuli. Behavioral slowing is observed in motor responses, reaction time, problem-solving abilities, memory skills, and information processing (Salthouse, 1996). Reaction time is a composite outcome of the lime ii lakes to perceive a stimulus, retrieve related information from memory, integrate it with other relevant stored information, reason as necessary about the required action, and then take action—whether that means the time it takes to press a button after delecting a signal, or the time it takes to complete a crossword puzzle or solve a math problem. Age-related slowing is more readily observable in complex tasks requiring mental processing than in routine tasks (Lemaire, Arnaud, &r Lecacheur, 2004). the more complex the task, the greater the processing load—that is, the more domains of information called into play, the more time it takes to select response strategies. The number of tasks presented in a sequence and trie complexity of choice required to make a response are all factors that influence response lime. Under conditions where a choice of response is required, older adults do not show evidence of slowing in the early phase of processing the stimuli, but in the executive functions associated with enacting the appropriate response (Yordanova, Kolev, Hohnsbein, & Falkenstein, 2004). In many studies, older adults show improvements in response lime when given opportunity for practice. However, when older and younger adults are both given opportunities lor practice, the older adults do not improve as much as the younger adults, and the performance gap may actually increase (Hem & Schubert, 2004). Biological, learned, and motivational factors have been identified to account lor behavioral slowing. At the biological level, there is evidence ol the slowing ol neural firing in certain brain areas which may result in ;. slower speed ol information processing. This is due in pan to age-related damage to the myelin sheath that insulates neurons and facilitates speed ol firing (Salat, 2011). The extent ol this slowing depends on the kinds of tasks and specific i ognitive processes involved. Speed ol processing may be only one ol many factors responsible for age-related < hanges in cognitive processing (Hartley, 2006). ( flder adult . appear to be effective in recruiting various brain regions in '■.....pensate for declines in processing speed which stimulates new patterns ol connections across the hemispheres ol lb'' brain. Research on brain functioning in later life finds evidence for plasticity and adaptive reorganization (Davis, Kragel, Madden, SrCabeza, 2012). The slowing ol responses may also be a product 0f learned cautiousness. With experience, people learn to respond slowly in order to avoid making mistakes. When confronted with new, experimental problem-solving tasks, older adults may lake longer because they are not confident in using a new strategy "1 hey may revert to a more Familiar, if more time-consuming, approach in order to solve the problem correctly. Thus, a conservative orientation to the selection of problem-solving strategies may resull in slowerrt^' iz0g, ; (Touron result in reduced sensory and inforrnation-P'ocessing capacities. Furthermore, response slowing »»> UCC a Pers°nfe chances of survival if a situation arises B» -r-a is 1*6' T'^ °lh^ haveT mi°n °r «u»e response , "ons, do not predict coff* J'101* n is wcl| In in their ™LWOrkl environments. 1165 Wkh age tnet iSrCd 'ha' s'Jeed of performance de-c a,e few real-world sanations thai re---' ;n laboratory quire the rapid speed that is typically measured in COO' conditions. As they age, people typically crea ^ing then11° ditions that are adapted to their abilities, allow ^ p0s- preserve effective problem-solving sible (Salthouse, 2012). Recall from chapter hood) that crystallized intelligence tends to in faCl„r 0 age, whereas fluid intelligence declines. Qc Quid >n' ,-for- sPeed <)/ res •PonSSUPPOr' !,'e claTm\age ^significantlyJess. fl** 'he do/8 acc°Unt for ' 1,tnat changes in [he speed o' re-^cew^^d evide; UetM'""^ proW* "? * The i aSe. 01 decline in intellectual per in a(e coi aeavtf nC'y'-^|c"eS' h°Wever> about whether this slo*-ev'de„er?''s"eeifit,() c,n8 a» types of cognitive and wrtf «1 £ C°'"eC CnUin d0ma'^ "'here is 0/'^Pon ance ul (°f res'3»"el,ng. /n each situation, ni"' s»«ati °7 "'a. are t ^ xbptive sdt«8***S ance; ann u pcr*ns, h UU of ^ the person assesses ^ l[y to control posture, movent Developmental Tasks 575 and dexterity Speed of responding will vary depending on what |ype of response is required and which systems constrain behavior (Newell, Vaillancourt, & Sosnoif, 2006). One 80-year-old *oman may be able to walk through an airport quickly to get to her gate but may be slow in reading and evaluating the tnlorma-u°n that tells whether her flight is on time or delayed. Anotnet 80-....................., K„ able t0 rcad the information about ■-- ~i lime but i that tells whether her flight is on Utne about —year-old woman may be able to rea Qn Ume but the (light and quickly assess whether may take much longer to get to thedep compensate Because slowing occurs gradually, ro nierU or by "luium: aiuwnig — o more coi^1-1 for ri by making their environments becornes more haz changing their lifestyles. However slowing ^ ^ ^ pace atdous in situations that require hway dnving with a....._______u" — "nl hp modified, suu ^ oldel- s that require the olcerau^ay tempo that cannot be naodihed s0me older or crossing the street with the light- o (rf^ lhe Ugh People encounter problems because me < ;_iiffident t0 permit >k encounter pmblenvsbecau^ stays green at a pedestrian crosswalk i ^ older people them to get to the other side of the street«, respond. 6 . _ :„ they nave , mav lecogt ill! 'pfiiraiaia Jtuwii—- eatery. tv>"— i «n to get to the other side of the s » J respond- :eogn.ze some situations in which they la may « quickly, they must review the tempo^ so that they eeome more selective to their choice of aa t0 lhem - uicKty, tney musL icv.^v,vines ~ -ome more selective in their choice rf£(^ ^ ^ allocate enough time for the ^ ;el and perform them satisfactorily. This n ^ ,(bouL whether control over their lime and being less l4.4). they are in harmony with the tempo otc Every sense tSens<>ry changes e modality-~'s vulnerable to age-related change. irnpac !niensily of stimulation is required to make the same lo\ver , °n [he sensory system that was once achieved v/ith he ■ eve'sof siininlaiion. Some of the changes in vision, ■ -"\„.n m -fable 14.1. These ry Changes , . taste, touch. «1 ^lU».-^S-SÍ '"I'^li on uie sensoiy =>y-~ r lbe ciiang^ l,Jwer levels of stimulation. Some fe l4l. faring, and taste and smell are given in^ ^ inc,,asc changes begin in early adulthooa,^ ^Q5) throughout die remainder oi hie . - . ,um,v to adjust Vision. Visual adaptation involves tne — (lccreases langes in the level of Ulummation. figure 14.4 As a result of behavioral slowing, it taKes ioi iS. elders'to perform daity tasks. Her trips to the market take May more time than they did 10 years ago, but she sli\\ enjoys her shopping and the satisfaction of preparing her meals with the best ingredients. with age, so thai less light reaches the retina,. Thus, older adults need higher levels of illumination to see clearly, and it takes them longer to adjust from dark to light and From he ability to adjust light to dark. Many older adults are increasingly sensitive -'-'•wises to glare and may draw the shades in their rooms to prevent l» ch-ai TABLE 14.1 age group 20-35 35-65 65+ VIS10N Constant decline in accommodation as lenses begin to harden at about age 20 Sharp decline in acuity after 40; delayed adjustment to shifts in light and dark Sensitivity to glare; increased problems with daily visual tasks; increases in diseases of the eye that produce partial or total blindness Pitch discrimination for high-frequency tones begins to decline Continued gradual loss in pitch discrimination to age 50 Sharp loss in pitch discrimination after 70; sound must be more intense to be heard taste and smell No documented changes Loss of taste buds begins Hicher thresholds for detecting 2at, and bitter tastes; higher SoW for detecting smells, and errors in identifying odors Based on Newman & Newman, 19B3- 576 chapter 14 Eldernood (75 Until Death) bright light from striking their eyes. Slower adaptation time and sensitivity to glare interfere with night driving. Some of the visual problems of people older than 75 arc difficulties with tasks that require speed of visual performance, such as reading signs in a moving vehicle; a decline in near vision, which interferes with reading and daily tasks; and difficulties in searching for or tracking visual information (National Institute on Aging, 2009a). About 1.6.5% of those 75 and older report that they have trouble seeing (National Center for Health Statistics, 2010). Several physiological conditions seriously impair vision and can result in partial or total blindness in old age. These conditions include cataracts, which are a clouding of the lenses, making them less penetrable by light; deterioration or detachment of the retina; corneal disease, which can result in red ness, watery eyes, pain, and difficulties seeing; and glaucoma, which is an increase in pressure from the fluid in the eyeball. The incidence of visual impairments, especially cataracts, increases dramatically from later adulthood (65 to 74) to elderhood (beyond 75) (He, Sengupta, Velkoff, & Banos, 2005). About 18% to 20% of elders experience problems with cataracts. According to vision experts, recent medical innovations have made cataract surgery much less complicated than it was in die past. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/40 and 20/20 (Lee, 2002). Problems with glaucoma can be treated with eyedrops, lasers, or surgery. Retinal disorders, especially age-related macular degeneration, can be prevented or treated with dietary supplements. Loss of vision poses serious challenges lo adaptation—ii has the effect of separating people from contaci with the world. Such impairment is especially linked with feelings of helplessness. Most older adults are not ready to cope with the challenge of learning to function in their daily world without being able to see. I;or them, the loss oi vision reduces their activity level, autonomy, and willingness to leave a familiar setting. For many older adults, impaired vision results in the decision to give up driving altogether, or at least night driving, causing a significant loss ol independence. I lowever, this loss can be minimized by the availability ol inexpensive, flexible public transportation. Hearing. Hearing loss increases with age. About 45% 0f those ages 75 and older have some trouble with their hearing, (National Centei lor Health Statistics, 2010). The most common efle< Is ol hearing loss are a reduced sensitivity to both high-frequency (high-pitched) and low-intensity (quiet) sound'; and a somewhal decreased ability to understand spoken messages. Certain environmental factors—Including exposure to loud, unpredictable noise, and injuries, such as damage lo the bones in the middle ear—influence the extent of hearing loss. Loss oi hearing interferes with a basic mode of human connectedness—the ability to participate in conversation. Hearing impairment may be linked lo feelings of isolation or suspiciousness. A person may hear things imperfectly, miss parts of curn»g in whisper'531!0"5- °r pe,cdve conversations as oc-■ Var'eiy of devices n in ordi™y tones. There are have heanng !oss can help support individuals who cievi^s that can m I mcIude hearin8 aids- a™P%inS ^sterns coordinate 'I CaS'Cr tc hear on the phone, alert COchJear inrp)am " w,th shells or smoke detectors, and come certain specifi " *K suig'cally implanted to help over-°n Aging, 2009b) *~ S °' hearing loss (National Institute c,al interactions°is?he^ hearing Ioss and ils imPact 00 s0~ °r cl>minis(]ed and', SICp in lcarnmg 10 compensate >s Wl(h and believ/ °'\ scnsi,ivi'y Knowing the people one Feassure a person ah , °nc is vaiued hY lhem (:an ^ SUsPidons. Elder.- 1',. "ature of conversions and allay m a r be ab,e to make th V with hi%h sdt-esteem is likely to P'"e' interactions an ,ecllml adjustment needed to inter-Such ^quests m-L ''Cc,Ucsl clarification when necessary-and Produce grJL, SeU'e 10 stimulate greater interaction Wlth 3 ,lea>'4 Jo 'my ,n communication. Older peep* PeoPfe who wan and hjgh sdf-estetm tend to insist thai lhem when theysn V°mmUniCate Wilh them shwU ^ like,y to be „ PC°PIe wh° have low self-es^"' -ehavi°r of othersT VuInerable to suspicions about & ,ecause they douhl their own Thev Zl Decause nicy ctouo at em" ^ Uk^ P-ccivc inaudible comment* eon, ° n;litUle °r delude them. These expert bii yz0 frlings of reJecuon -d -n produce /andsocial withdrawal, sory lT 20% °f *<* ^s 75 and older have muluf Zl 2airmenlS- *»* wl- have both visual and hejj -ion 7l 1 a'" m0re ,lke'y *> report reduced social tfj ASS n! ge;i;ng iogeihei-wiIh friends-and are is* supnor, „ ' S,b,y due the lack of sensory cues thj" 1 Ration in unfamiliar settings (He et al., 2005> h- Taste and Smell. There are taste receptors thtj^,, out the mouth, including on your tongue the roof ^„ mouth, and your throat. These taste receptors e ^ 9n of food based on five tastes: sweet, salty, bittet, ^^* langy. In addition, the smell of food contributes^ ^fir and many would argue that the appearance o buste-adults for delecting sweet, sour, bitter, anc^ ^ Some of this reduced sensitivity may be 50" pact of certain medications, eum disease, den (fi the infections, cancer treatments or alcohol consUdP tional Institute on Aging, 2009d). In order to "l1pjciam^ taste of food, older adults may add salt or sugar, ^^re0* aggravate existing conditions such as high blood p diabetes (Figure I 4.5). Developmental Task: 577 •K^ft.V-- c0urce of pleasant ««« h.5 The sense of smell continues^^ ^ ^s w Emories and invigorating daily expe lllacs, a delightful sign that spring nas --vi's ;lr)(.| eqiure greater intensity to detect ^2zole ■ ai"e more "ln 0| aste may resull in a loss ol' appetite or a cli\sj-ii/i-c°rnpari 0,!lla' e;UinK habits. Loss of appetite (which may ac-^r°0fems SS a,K' new medications), pain due to denial lo "^iln ' Cnanges in the digestive system all contribute "tnti°n among the elderly. "its patf Sensory changes. As a result olthe vari-'5|'esCrjj:)eins °' a8ing among the very old, il is impossible to in, C an ,c'eaJ pattern of coping. The SOC model, which ^reasj ,Uced m chapter 13 (Later Adulthood), becomes ')ill!'t'cl ^ rc'cvam as sensory and motor functions are im-°'cler g L(C0!ding t0 ln]s mocje]) ;n or£Jer t0 cope effectively, Vestedi musl seJecl lnc areas w'1crc ''IC)' are mosl in~ s°U!ces . SUslaining optima functioning and dived {heir re-;"'e;is ,n 0 ennancing those areas while compensating for the toachi ' ,Unctioning is more limited. Whal one hopes 'e ls a balance between seU'sullieiency and willing-°)n nreserving one's dignity as much as pos-' This is desci ...eve is a balance betw*» - uy asn - ^ to accept help, pesennjj^W^^dd: s*le and optimizing day-to-day n ^ ol the ver) ^following excerpt from Enkson Appropriate dependence can be accommodated and accepted by elders when they realistically appraise their own physical capacities. One ol our more practical elders simply states, "Of course, you're still interested in everything. But you don't expect yourself to do everything, the way you used to. Some things you just have to let go." However, inappropriate restriction can be, in its way insulting and belittling. In describing his current life, one widowed man expresses both his refusal to accept restriction and his willingness to rely on appropriate assistance: "1 can stay up here in the woods because I know if I really need help, my son will be here inside of three hours. Now, this deal with fixing my own water pipes, I'd have never tried that without my son so nearby, and 1 didn\ even need him." (Erikson et ak, 1986, pp. 309-310) Health, \\\ness, and Functional Independence How can we characterize the level ol health, illness, and functional independence in later life? A nu\d but persistent decline in the immune system is observed as a correlate of aging. As a result, older adults are more susceptible to infections and take a longer time to heal. Substantial numbers of older adults are afflicted with one or more chrome conditions, such as arthritis, osteoporosis, diabetes, or high blood pressure which may require medication and interfere with daily functioning. Older adults are at increased risk for developing chronic conditions, the most common of which arc: diabetes, arthritis, congestive heart failure, and dementia (U.S. Department of Health and Human Service, 201 )). Nonetheless, 39% of those aged 75 and older describe their health as very good or excellent, and 55% report [heir health as good (Schiller, Lucas, Ward, & Peregoy, 2012) Osteoarthritis is the mosl common type of arthritis for older adults. This type ol arthritis results when the cartilage thai pads bones in a joint wears away. The joints may feel stiff when a person has not moved for a while. Other symptoms include temporary or chronic pain and gradual loss of mobility in the affected joints. Fifty-four percent of those 75 and older have osteooarthritis. (htcopoivsis is a disease thai weakens hones so thai they break easily. Bone tissue is continuously broken down and replaced. Willi age, more bone is losi than is replaced. Although women are ai greater risk of osteoporosis than men, alter age 70 men and women lose bone at about the same rale (National Institute on Aging, Data from the National Health Interview Survey (Schiller, Lucas, Ward, & Peregoy, 2012) provide a look at the relationship ol age to difficulties in physical functioning. Participants were asked about whether they had certain upper-body and lower-body limitations. Upper-body limitations included such things as reaching up over one's head or using ones fingers to grasp a handle. Lower-body limitations included walking for a quarter mile or stooping, crouching, or kneeling. The percentage of respondents who reported difficulty 578 I chapter 14 Elderhood (75 Until Death) in one or more areas increased from 30% of those ages 65 to 74, to 46% among those 75 and older. The area of most difficulty was standing for 2 hours, with 30% of those over age 75 reporting difficulties. This suggests that many elders would not go to an outdoor concert without bringing a chair. One of the most difficult health challenges of elderhood is a group of disorders referred to as organic brain syndromes. These conditions, which result in confusion, disorientation, and loss of control over basic daily functions, present obstacles for adaptation to the person with the disease as well as the caregivers who are responsible for the older person's well-being (see the Applying Theory and Research box Dementia). Do people generally experience a rapid, general decline in health alter age 65 or 70? Not according to self-ratings. In a national survey of older adults, people were asked to rate their health from poor to excellent. In the 75 to 84 age range, 76% of non-Hispanic Whites, 57% of non-Hispanic Blacks, and 60% of Hispanics rated their health as good, very good, or excellent. Among those 85 and older, the percentage who rated their health as good, very good, or excellent declined somewhat Tor the three groups, to 69%, 55%, and 52%, respectively (federal Interagency Forum on Aging Related Statistics, 2012). However, the majority continue to view their health in a positive light. Among those in their 80s and early 90s, one health-related crisis may result in a marked decline in other areas. For example, the loss of a spouse may result in social withdrawal, loss of appetite, sleep disturbance, loss of energy, unwillingness to take medication, and decline in physical activity. All these changes car. produce a rapid deterioration of the respiratory, circulatory, and metabolic systems. Studies of people in their later 90s and older find that these elders demonstrate unexpectedly good health. They appear lo be more disease free than those who are 10 or 15 years younger. Perls (2004) suggested that a combination of genetic factors protect some people from the diseases ol aging through two complementary processes. First, they are less vulnerable to some of the damaging effects of oxygen radicals that destroy DNA and cells, "thus, during their 70s and 80s,they do not suffer from the major diseases such a ; heart disease, cancer, stroke, or Alzheimer's disease. Second, they have a greater functional reserve, meaning that they require less ol their organs to perform basic adaptive functions so they can tolerate a degree ol damage without losing basi'- capacities. Studies of centenarians confirm this view ol aging; they typically have a short period of poor health before death rather than sullering from prolonged disease-torn illness and disability. In contrast to negative stereotypes about later life, the level of independent functioning among adults 80 years and older is high. Figure 14.6 shows the percentages of nonin-stitutionalized people in three age groups who needed help in six activities of daily living (ADLs): bathing/showering, dressing, eating, getting in and out of bed or a chair, walking, and using the toilet. The area of greatest limitation is FIGURE 14.6 Percent of Persons with Limitations in of Daily Living by Age Group: 2010 source: Administration on Aging (2012). Activities small to walkings The percentage of adults needing assistance is srr nose ages 65 to 74, increases slightly for those ^ »4 and ,ncreases funher thos£ ^ ^d oMer Ver, even among this oldest group, fewer than half require he P with walking, and fewer than 25% need help with Others * tasks of self-care (Administration on Aging, 2012). ^ he Past decade, the proportion of elderly people repor h needs h« .......- m,..„ r„.......B JIV account for** mprovenrent in daily functioning for recent «« ^ry °ld, including improved design of interior space m ST""* "eW dcvices that ™ke il ^sier for older i** heln lnPenSaLe f0r <3h^a' limitations, and medications tb» evtate the symptoms of chronic illness. 7"7nEFLECT'ON: D™ribe someone you know v& #> Wife stagg ofeldernMd what chdlenges is this no facing? Haw is he or she coping with these challenge Z1 T°mmal md/or socJsupports are recced to Y# Perspe^iV8 * Psychohistorical . objectives. Describe the concept of an altered Perspective on time and history that emerges fong-lived among the Development in elderhood includes gains as well Through encounters with diverse experiences, dec* tgh encounters with diverse experiences, _ntorin£°j mg, parenting and other forms of tutoring or pers0^ younger generations, and efforts to formulate ^gtoj philosophy, adults reach new levels of consci ^ey C» Very old adults arc more aware of alternative^ look deeply into both the past and the future ^L^z^9", nize that opposing forces can exist side by sldc , {h\5 i'1'" & Baltes, 2005; Riegel, 1973). The Ptodnf ^0** °yC gration of past, present, and future is the s0{d& psychohistorical perspective. Through a pr°ceS Developmental Tasks | 579 v ure14.7 Wendell tolls his Lu„ng llsteners what it was like to 0 soldier in WoM War II. Through s stories, he makes this period of /nerican history come alive for a new generation. elders in each generation blend the salient events of heir Past histories with the demands of current reality They re able to consider the contextual variations and uncertau-CS are inherent in trying to make sense of hfes ch£ nf s. Having lived a long time, and envisioning ks t ? 'uture, elders are more likely to be more J^ted in material accumulation, and more locu do ^Otional satisfactions of life (Alkmand, 2008, Biandl lacJ*r. Rothermund, Kranz, & Kuhn, 2010). v lh>m< about wha it means to have lived for 7 o m fw».TTio ' ---^ were 80 years old in 2011 were borr, i, War |i „ on years old in ^ ld -se adults who were 80J ^ g W n in the Great Depression- 1 nc) ......,he ClUll ,, , „ ........- the 1 [he ,-\|-^ le Korean war; the Vietnam war; the Guli war; ^CT'hecl n anC' 'rac'' wars> '',e assassinations ofPresidenl ^gatefj bert Kennedy, and Martin Luther King, Jr.; Wa-[he te ' le dnion impeachmen! (rials; the AIDS epidemic; desU0y °rSt aUacks of September I I, 2001; the Hoods thai Orleans; and the election of ihc Rts\ ''lie;,! |^ lner'can president. They have experienced the po-11 '"'c During their lives, they • com- 'Ca' le d eriCan president- rhey havc ex''L" We ad ersn'P of 14 presidents. During their lives, they """ll)icar':"eC' t0 dramatic technological innovations in com-^ducf >n' LransP{-5rtaii(Mi, manufacturing, economics, (ood e*perietl°n' eisure activities, and hca/lli care. They have also One • Stn^ing changes in cultural and political values. ouence of a long life is the accumulation ofexpe-' - "hange is a basic element c^Pmenced striking changes in ^ ^ acCumuLa^. One consequence ol a long h nge is a P h e ***s. Another is the realization ** ^ Sometimes, tft^ oi all We at the individual and soc ^ ppeat ^ ^nges ;1nn(..,r rVclical; at ottier who are of eh teal ■ transformations. For exrnP1 ' 1 1Tlcn were in R0 lived durmgWorlcl War U vvl^n .......the '0'licn WC,L,. the 1950s, ■■al during Woriu v»« - , . lhc mil«ar(' d c0m-labor market while men serve ^t ^ 'en many women withdrew lion ^ lhe | Whe the present when it has become normative for women to be employed outside the home, even when they have very young children. The patterns of behavior that younger adults might view as normative and necessary, elders may recognize as part of (luciuaiing social or historical conditions (Figure 14.7"). Within the framework of an extended life, elders have opportunities to gain a special perspective on conditions ol continuity and change within their culture. In the process of developing such a psychohistorical perspective, (hey develop a personal understanding of the effects of history on individual lives and of one's place in the chain of events. As society becomes more accustomed to having a significani group of elders functioning in the community, some scholars anticipate that a culture oj aging will emerge in technological societies. This culture is likely to provide more opportunities for the expression ol the pragmatic wisdom accumulated over a long lifetime through theater, music, the arts, and critical commentary. Ai the same time, new roles \v\\\ evolve lor successful agersas mentors and advisors to the young (Kun zmann & Bakes, 2005). In the United Kingdom, pensioners have created the Retiremeni Lounge, an online selling where retirees can interact and share their experiences: Social interaction is extremely imporiani when we leave work for good. We are no longer in the working environment to share a joke or gossip with our colleagues. Sadly, many retirees get trapped in their home environmeni with no one to talk to apart from their family members, if they are fortunate to have them around. With that in mind, this portal is set up to serve the needs ol senior citizens. This is a Pensioners Corner. With our pool of experience and knowledge base we should be able lo help each other. (ieiirement-lounge.com, 2013) many women wu»--fitted themselves to working at 580 1 chapter 14 Elderhood (75 Until Death) APPLYING THEORY AND RESEARCH TO LIFE Dementia Dementia is the loss of thinking, memory, and reasoning skills that significantly impairs a person's ability to carry out daily tasks. Symptoms include the inability to remember information, asking the same questions over and over again, becoming lost or confused in familiar places, being unable to follow directions, or neglecting personal safety, hygiene, or nutrition (National Institute on Aging, 2009g).Two of the most common causes of dementia in older people are vascular dementia or repeated small strokes and Alzheimer's disease. With vascular dementia, the supply of blood to the brain is disrupted, resulting in the death of brain cells.The loss of function may be gradual or relatively sudden. The symptoms vary depending upon which area of the brain has been damaged. Memory, language, reasoning, or motor coordination can be disrupted. Supportive counseling, attention to diet, and skilled physical therapy to reestablish control of daily functions may restore much of the person's previous level of adaptive behavior provided that additional strokes do not occur. Alzheimer's disease produces a more gradual loss of memory, reduced intellectual functioning, and an increase of mood disturbances-especially hostility and depression. An estimated 5.4 million Americans had Alzheimer's disease in 201?..The incidence of this disease increases with age, with few people below the age of 60 affected by it, whereas an estimated 45% of those ages 85 and older have the diagnosis.The severity of the disease also increases with age (Alzheimer's Association, 2013). A person with Alzheimer's disease experiences gradual brain failure over a period of 7 to 10 years. Symptoms include severe problems in cognitive functioning, especially increased memory impairment and a rapid decline in the complexity of written and spoken language; problems with self-care; and behavioral problems, such as wandering, asking the same questions repeatedly, and becoming suddenly angry or stubborn (Kemper,Thompson, & Marquis, 2001; O'Leary, Haley, & Paul, 1993). Currently, there is no treatment that will reverse Alzheimer's disease. Treatments address specific symptoms—especially mood and memory problems —and attempt to slow its progress. As the number of older adults with Alzheimer's disease and related disorders has grown, the plight of their caregivers has aroused increasing concern (Roth et al., 2001; Zarit, Femia, Kim, &Whitlatch, 2010). Most Alzheimer's patients are cared for at home, often by their adult children and their spouse.The caregiving process is ongoing, with an accumulation of stressors and periodic transitions as the patient's condition changes. As the symptoms of the disease progress, caregivers have to restructure their personal, work, and family life. Caregivers often experience high levels of stress and depression as they attempt to cope with their responsibilities and assess the effectiveness or ineffectiveness of their efforts. Over time, they are likely to experience physical symptoms of their own, associated with the physical and emotional strains of this role. When people with dementia are cared for at home by their spouse, children, or other relatives, three spheres of functioning intersect: home life, intimate or close relationships, and custodial care. Custodial care, often involves routinization, surveillance, and indignities as a result of lost capacities, such as needing help with toileting, bathing, or dressing. Observations and interviews with caregivers and care recipients who live together sug9eS mat these features of custodial care disrupt intimate relationships and home life, making daily experiences more monotonous, restrictive, end constraining. As their symptoms ^ worsen, care recipients gradually 0 many of the functions that supp°rt fheir identities as homemakers, parents, or intimate partners (Ask Bn'ggs, Norman, & Hedfern, 2007 .'(h The care of an older person Wi some form of dementia is fraufP with problems and frustrations, 0 it also provides some opportune for satisfaction and feelings of encouragement {Pinquart & Sorensen, 2003).Tbe uplifts and hassles frequently reported bV caregivers give some insigM i"10 the typical day-to-day experlen°e of caring for a person who is Another online resource is sponsored by T1AA, myrelire-ment.org. It has over 13,000 members who share ideas about weekly topics, access information about current trends, respond to surveys about topics of relevance to older adults and read about the results, share aspirations, thoughts, and photos with others. Other sites where older adults are sharing their expertise include coolgrandma.com, senior.com, eldercareon-line (econline.com), seniornet.org, and senioryears.com a differ*1 rf leaders, The ^lú^L example of how people can bring their Ufe ^ fht$ An international group of bear to address critical issues (www.theelders.o'g ^ see'^ was formed to help address some of the fiell0"lc'l A fe , ingly intractable problems that plague <)U1" w°s the ol p(J ise of this group is thai in traditional society^tfp** members of the group were looked to for tb«>r ^ tot making sense Care recipient's forgetfulness, asking repetitive questions Care recipient's agitation, anger, or t ^fusing help ' Care recipient's bowel or bladder accidents * Seeing care recipient withdrawn < 0r unresponsive * Dressing and bathing care t recipient, assisting with toileting | Care recipient declining physically Care recipient not sleeping trough the night TWo of the symptoms that are ^0st difficu|t to manage are sleep •^urbances and wandering. As n9nitiVe functioning declines, Co th Ae Pattern of sleep deteriorates. s|ePerson with Alzheimer's disease na eps for only short periods, Pping on and off during the day an i • uurmy me " n'9ht. Often, the napping is accompanied by wakeful periods at night, during which the person is confused, upset, and likely to wander. Caregivers must therefore be continuously alert, night and day. Their own sleep is disturbed as they try to remain alert to the person's whereabouts. When the disease reaches this level, family caregivers are most likely to find it necessary to institutionalize the family member. Alzheimer's disease is a major cause of hospitalization and nursing home placement among the elderly; an estimated 50% of nursing home residents have Alzheimer's disease or a related form of dementia (He, Sengupta, Velkoff, & DeBarros, 2005). A woman who remembers her mother as independent, with strong views and a deep commitment to social justice, describes some of the ups and downs as she witnesses her mother's condition: My mother also had strong views on quality of life issues for the elderly. We had often spoken about the importance of being able to die in a dignified way. She has a living will and opposes heroic measures to prolong life. I am convinced that Mom wouldn't want the quality of life she now has. She can't express herself, is unable to hold a knife or fork, has no control over her bodily functions and can't walk. However, on a recent visit to her mother, who is living in a group home, she describes the following scene: I worried.... that Mom wouldn't recognize me this time. But when I got there, she looked up at me and broke into a huge smile. She was truly excited to see me. She laughed and as I hugged her, we both cried.Then she began to speak nonstop gibberish. Although she can't tell us otherwise, my mother appears to be happy.... I honestly don't know if she has any thoughts about quality of life. (Simon, 2002, p. B7) Critical Thinking Questions 1. Imagine that you are responsible for the care of a loved one who has Alzheimer's disease. What steps could you take to help support their optimal functioning? 2. Hypothesize about psychosocial development for adult caregivers. How might the responsibilities of care contribute to or impede their psychosocial development? 3. Explain why sleep disturbances and wandering are the symptoms that are most likely to lead to institutionalization for those with Alzheimer's disease? 4. Hypothesize about why an adult child may want to care for a parent who has Alzheimer's disease rather than place him or her in a nursing home or extended care facility. 5. Imagine that you were to take on the responsibilities for someone with dementia. Describe how you would prepare for this role. How would you plan for the long-term nature of this responsibility and cope with the continuing deterioration of your loved one? wnerc the conflicts are uu<-....... . ncec| 0\ i cultural nature, the global community^ 1> of respected and trusted leaders who an o often of alternation al and d of r^P of respected and trusted leaden. *,- -■ dus. ^ ^thout a vested interest in a part.cula, natron ^ Ulal, or . _______ -rw founding rrtern.De Ti,„ founding me j, ieugtous advantage. Lne iou Wjse Elders are characterized as "truste l rsnected woildiy-- ';'"c»-.s are characterized as "trus.ed, resp ^ q( *e ^dividuals with a proven commitmen luting to snlvin, dobal problems, fhecui of Elders includes Marl11 Ahtisarri, Nelson Mandela, Graca Machel, Desmond lulu, Kofi Annan, 1:1a i'.haii, Lakhtlar lira-liimi, Gro Brundtland,Jimmy Carter, Fernando 11. Cardoso, and Mary Robinson. 7/ir Elders hopes to share their wisdom, forged over a long lifetime, and opportunities for international leadership. As the example of The Elders suggests, a psychohistorical perspective contributes to the wisdom thai the very old brine 582 ; chapter 14 Elderhood (75 Until Death) lo their understanding of the meaning of life. As a result of Living a long time, a person becomes aware oi life's lessons as well as its uncertainties. The integration of a long-term past, present, and future combined with an appreciation lor the relativistic nature of human experience allows these adults to bring an acceptance of alternative solutions and a commitment to essential positive values. We are all part of the process ol psychosocial evolution, bach generation adds to the existing knowledge base and reinterprets the norms of society for succeeding generations. Elders are likely to be parents, grandparents, and great-grandparents. Many are seeing their lines ol descent continue into the Fourth generation, which will (dominate the 2 1st century. The opportunity to see several generations of offspring brings a new degree ol continuity lo Hie, linking memories or ones own grandparents to observations ol one's great-grandchildren. We can expect the value of the oral tradition ol history and storytelling to lake on new meaning as the elders help their great-grandchildren feel connected lo the distant past. We can also expect a greater investment in the future, as elders see in their great-grandchildren the concrete extension of their ancestry three generations into the future. Erikson (Erikson el ak, 1986) identified the emergence ol these tendencies in the very old in the following excerpt: The elder has a reservoir of strength in the wellsprings ol history and storytelling. As collectors of lime and preservers of memory, those healthy elders who have survived into a reasonably fit old age have lime on their side—lime that is lo be dispensed wisely and creatively, usually in the form ol stories, to those younger ones who will one day Follow in their footsteps. Telling these stories, and telling them well, marks a certain capacity lor one generation lo entrust itself to the next, by passing on a certain shared and collective identity to the survivors of the next genera-lion: the future, (p. 531) FURTHER REFLECTION: Explain the concept of a psychohistori-i :il perspective and evaluate how it contributes to psychosocial developmenl in elderhood. Reflet t on any conversations you have had with someone that offered a unique perspective on time, histoi v, and self-awareness. Traveling Uncharted Territory: Life Structures in Elderhood OBJECTIVE 4. summarize elements of the lifestyle structure in elderhood, especially living arrangements and gender roles, and analyze the impact of these life structures for continued well-being. behavior, and what expectations do others a arCgs-When we talk about traveling uncharted terrlt°^ lhel-e are suming that elderhood is a time of life for WW .ngtrieir lew age-specific social norms. The very old are cn^ ^ £X. own definitions of this life stage. You may have 1 _ ^ pression "Life begins at 80." One inle^relal'°"^vl0r and s° is that because there are so lew norms for x^* „nf> can d° lew responsibilities when one readies elderhoo , whatever one wants. j£ |osS in l''liel Changes in role relationships—especially ro c^ serva-adulthood—present significant challenges to ^ere's lion of a coherent self-concept. In early adultn • b. . ' ......-oles and u> . an opportunity lo engage in many new '°lers ,,q Derst"i: £mty- ln ™me CTnXS "lc Priom* of one's pe n 0,n'x'(^es D u Llllm,h ^nges in then social and ces?f M^'A,-(hur ^''/fetings, &r Stamen. 2001). ;',SciP''nary e & Kahn, w98) has offered a new. h>-, f"Cccssfu' .Bin "r,VC °n the Jetton between usual S be f«n«/oni E t , 10'Se ^acterized by usual *gM "X reduZZ bW are 31 for disease, *• in, C<',n"'asl> sue- CaPr'CUy for functional independence erdependcm .^ssfui agers are charac£erized by three ' °l dl**se an," fe p^re 14.8). They have a W lse*se-related disabilities; high me"; -on, with lib tal and physical function; and active engage1 l ^ [req«eI1 5 (p. 38). This last Feature, active engagement, repeated theme in the held of gerontology. 1 low should elders behave? What norms exist to guide their social relationships or the structure ol their daily lives? What does a healthy 85-year-old woman consider appropriate FIGURE u.8 components of Successful Ag^|NcwY(»k Source: Adapted from Successful Aging, by J W. Ruwe & n. L M™ ■ pa"1 .1.6'"' Developmental Ta: sks 583 FIGURE 14.9 Typical Drawings That Researchers Might Use to Establish the social Norms of Very Old PJ0P» soutce: Drawings based on Oftenbaoher and W ■ - ^er adults use In an effort to deser.be the older adults to guide their conduct, ****** *£orgia, to respond [ro......■•.....Qavannan, u °._ pil)Ure -ucte tneir eonuu^M ■ - , rjeorgi*. " >l4o New York City and *vani»fc m Figure ^y six pictures similar to the two diaWU^ ^ ^ loll0w to six pictures similar to tne st,0nses w — (Offenbacher & Poster, 1985). fhe csp ^ ^ Q, conduc ingtwo questions were used to con t "How do you think that people who to v?„ ^ n 0vv do as family oT friends, feci about htm or iples were '"-■w uo you tnuiK r—> „• pei: , . „,«,« as family or friends, feel about htm o.^ we,c y°u feel about this person? Fom I in the responses: Don't be sorry For yourself- 2- Try to be independent. 3- Don't just sit there; do something. 4- Above all, be sociable. Thi tha i- ,r or chile Ider people belief ^ ^ ";" bein °' n>nc'uc' suggests that o Cessuj| j. , 0ciarjle, active, and independent eonstiiuie sue-t1,(jne jn VIn8 in later life. Of course, aider adults are noi '^Portau 1,1118 ''1CSe clLla'llles- However, these norms are ,:)l'0,no(e ''S source« of sell'-cslecm for [his age group. They kcoura ' SC11se °' v'igor and a shield against depression or 'he-re"Sl emes Dun'i be sorry for yourself and "Don't just sit reWerrthal eIders continue to see their lives as precious ''lce"inh- nC" t0 'x' waslcc' sel'-pily and passivity, astern 7 °n ;,clivi(y as opposed to meditation ir/lects the iiS ^ghlv°U 3' Va,LIC °' a se"se ^"O'—thinking is not '"i ittip^.tV3,Ued as anion, hi contrast, doingihino^ having Proving ti ' anci '"eeeiving the feedback that iiciion siinmhues spotted ', co-residence with adult sons and their to was Illorc common ,n As.a ,.....n_residence ™h adult daughters and their families was Laun America. In countries with higher lever i: , f"neral Population, families were more likely to have nuclear households with older adults living alone (Bonga^5 Zimtner, 2002). Living Alone. One implication of these trends in livingf ^gements is thai increasing numbers of women are establishing a new single lifestyle in which they function as heads Z '"^holcls a, ages 75 and older. Though still in «f« social interaction and support services, they are often relief me resPOnsibiliUes of caring for spouses who were ill V be freer pending on their own health, these women may - nsing to live alone. Those who immigrated to he Uni ed al^s before 1965 or who were born in the United Sta cs;»c > likely to live alone than the more recent «rants. U a ^mparison among the Asian American cultures, olde. ^ ' t . i, Most older women who ve dtonea^ ^ t pendent life style. Charlotte enjoys lie ^ * care of Sts from family and friends, and does not hdvet ,lyo"e but herself Japanese women were more likely to live alone than the Chinese, Filipino, and Korean women. Consistent with patterns lor European American women, the more children these Asian American women had, the less likely they were to be institutionalized (Burr & Mutchler, 1993). Older African Americans are more likely than other ethnic groups to live in large households where the membership is changing over time. In a sample of older Floridians, the African American elders were more likely than other groups to form co-resident relationships with their grandchildren and other nonrelatives. As marital status, aging, and disability or health needs of family and fictive kin dictated, African American households were more likely to add new members (Peek, Koropeckyj-Cox, Zsembik, & Coward, 2004). The majority of men aged 75-84—about 72%—are married and live with their spouses; only 16% are widowed. In contrast, 37% of women in this age range are married and living with their spouse, and 48% are widowed ("U.S. Census Bureau, 2012a). Widowed men are much more likely lo remarry, which they lend to do quickly However, remarriage among the very old is still a new frontier. Sexual and social stereotypes inhibit some older people from considering remarriage. Also, potential financial consequences may make remarriage undesirable. For instance, a widow may lose her husbands pension or her social security benefits if she remarries. However, some older couples cope with this problem by living together instead of marrying. From 2000 to 2010, in the U.S. the number of unmarried, heterosexual couples over the age of 65 who were living together increased from 193,000 lo 575,000 (Creamer, 201 I). In contrast to those older women who live alone and those who live with a male partner, an emerging strategy is for several older women to live together, This alternative acl-resses the increasing costs of housing in many communities s well as the growing research evidence about the health and menial health risks of social isolation and loneliness in later life. Women of the baby boom generation are more likely lo have experienced divorce and have smaller families than the previous generation ol older adults. Many of these women have developed and nurtured friendships with other women -oiii their high school and college years, in the workplace, and through community participation. As they begin planning lor later adulthood, I he idea of sharing the cosis and responsibilities with good Friends can be quite appealing. "We lived together in dorms and sororities. We shared apartments alter graduation. We traveled together. We helped each other through divorce and the death of our parents. Why not lake ii to the next level?" (Cross, 2004, p. I). I interstate Migration. I he great majority of older adults (more than 95%) remain in their home communities as the)1 age, many preferring to stay in their own home, even after their children move out and their spouse dies. Yet the trend toward interstate migration has increased since the mid-1960s. Each year, roughly 1% to 2% of those 75 and older move to a 586 chapter 14 Elderhood (75 Until Death) new residence across slate lines (U.S. Census Bureau, 2012a) Many of these older interstate migrants will live out their lives in communities in which they did not grow up, work, or raise their children. They are pioneers, establishing new friendships, community involvements, and lifestyles. Another group of older adults return to their birth state, especially after one's spouse dies or, in the case of serious disability, in order to be close to family caregivers (Stoller Sr. Longino, 2001). In ihe lace of some new physical limitations, older adults may warn to be able to remain independent but require more help. By moving back to their home community, they are more confi- 25% of those 05 ' "cM I dent about being able to draw on needed support from lam- 7vy „r , i ■ ^ , ily and friends (Rowles & Ravdal, 2002). In addition to W n Tr nUfSmg h°mCS ° ,increases«*f permanent moves, many older adults participate s^, In" W ° / "I"0" ^ \ ™™\ Zl ■ i , r i v seasonal there is no am v member who can help to n" f.iKaie migration—residents from southern states eo north fr>r th* i- ■ , } "iemiJU w 1 ,.iP, adults. ii r , S me ,lvlng needs People lend to think thai once olciei summer, and residents ol northern stales go south lor the • winter. Over time, some of these seasonal migrants decide to establish a permanent residence in the state they visit. This is especially likely lor northern residents who establish permanent residence in ihe South (Smith & House, 2000) ave n.t Housing Options. Differences in lifestyle, health, interest, ability to perform daily activities, marital slants, and income enter into the very old persons prelerence for housing arrangements. Housing lor ihe elderly—sometimes referred to as retire-meni housing—has expanded dramatically, and developers havi experimented with a great variety of housing configurations tha are intended to meet ihe special needs of particular aging populations (Shapiro, 2001). These options range from inner-city hotels for those with minimal incomes to sprawling luxury villages with apartments, medical clinics, and sponsored activities. Retirement communities are typically age-restricted residences. They may be apartments in a high-rise, lownhouses, or homes with shared recreational resources, like a Illness center, pool, or golf course, and social and cultural programming. Often, they provide the option lor prepared meals or a communal dining center. I ife satisfaction in a retirement community may depend on the lit between ones marital status and the demographics of ihe community, for example, one study assessed ihe life sal-i,Inchon of widows who were living alone in retirement communities. When widows outnumbered married couples in the community, the widow, bad a high frequency of seeing friends and partii ipating m activities. I lowever, when married couples outnumbered widows, the widows experienced less satisfaction and were more socially isolated (I long&r Dull, 1004). I he majority ol older adults live in urban areas, and 51% live m i.....a city neighborhoods. As a result, any economic factors thai affecl the housing options in urban communities have a significant impact on the living arrangements of older adults (see the Applying Theory and Research box The Impact of Gentrification on the Elderly). Because older adults tend to have a limited income and depend on the quality of community resources and social support lor their well-being, moving can be an especially difficult life event, adversely affecting their overall well being (Pynoos, Caraviello, &r Cicero, 2010). 65 Ilve in sinalizaiion increases with those ages 65-74 Y snPP°tt- 'n 20lt\ about .9% ol 2J% of those 05 - !T. ,Z in a nu™ng home; but almost 75% "''people in Cr We,e in (Jlis kind of facility AboU! ,ike,*ood ofa nc - ""ffng homes do have spouses. The there is no fa '., S0" ,,V'"S in a nursing home increases when to in; ad«»tted to a nJ i ° ^ think that once older ™<...... 'acl' the* is a hih me' lht'y slaX *ere until they die. denls- The avenf Ulniovcr among nursing home resf-"* °f Health ! u8th 0,'sla>' * °" months. The U.S Depart' 'Pie will „T Human S^viceS estimates tha. about 37* isted living ok merit of H h s" ^"fita of stay is 6 of rvn«i , 3nd Human Services estimates that -P ople wtll use some d ljving c* f % m their lifetime, and that peopk use this type of conv l Cn' 3 pcrson enters a nursing home for a I " Z t0TiSCetlCe hospitalization and then returns ^ ' sul|ng that provides le« ;,,„■,„;„,. rare (Figure H-J or to a get, ■ ^ospnanzaiion ana tm ' mg that provides less intensive care ,. care ,n«a"d n ' ^"""y ' 5*" 3 Cw"""u" residen, £d,ca', preJ, , ,es,ckntml setting offering Oncel Wh° «* wen 'Ve heaIth. sodal services ro come m Uted. they at! e "nic they enter the commune tame ,, °rdisaoled fcj 8Ua,a'"ecd nursing care if (hey be-IT T0nS resident' 2°°a ,n a» a™lvs's rfBOflW °% apn, ^ of l,e,nLM,n C°,minuingcare retirement corn-s - ; the rate for older-**41 'Hirsi,' C°ile". rejj g" the fength of stay per admission «*' than S °n"' «a«y be ?' ^,,iad<» & ^LcK 1989). This ,:T^ Pa" bribed f Va'1(a^ . V man'1ge a" d^ rf-^f . y G!en" Sm,'^. C°n"^"'n« care community * di" Syeit0,a s'^^ T a«e s[rL'^e when one V/orn 0,d Glenn s! g faciJ"y 6 ^away,"*)* hkZ?°V*toLnf '"^n someone 1 Jo drive ''■on , V<'r Va»ey 4 a'°P a overlooking Oregof is a ! hc,r sPaciou, nUrsin« horne is just a short wf Move ^ Coi'^ c, bedr°°m co«^e- Smi£h'VW"' tat r ? yo , n,n,s"'al°'-. has one bi. o/ advice; enlM/7" ad^nLe 0a;70u"ger and hca/,hy in older to '^'°',p. 60) Developmental Tasks 587 figure 14.12 At 97 years of age, Stella has had to move into a nursini h°me because she can no longer w*. Periodic visits from her great-grandson keep her in good spirits. Hs Plays, and she is a most appreciative audience. The costs of a continuing care c and eXtet tensive and vary depending on the Jitlnnshave services provided. Recent econo ereaied fir.sr.rial difficulties Id • -^onth' conditions services provided. Recent economy ^ ^ created financial difficulties oi son ^ohave which raises the possibility tha PL ^ therms vested in a long-term contract BWy^ 20)0). a Eacihty that faces bankruptcy - J ^ ^ ^ ^ in Place. The fastest ^iSn^^X^ ^ program is community-base ^ (Q ^o5e ^ *hich provides medical and socta ^ionbutw ^ cWally ill and eligible for insOW» ^ 42 lb ettMess, live in the community. a i ^ designed adult? „..-........... „f naid home r»u __^msare des e^onically ill and eligible tor esdrflated ^ (long- ettMess, live in the community a i care ser^ d stilts use some type of paid home are n[_ ^tcarc.gov, 2013). At their best ^vtafr ^ ll0 are t0 implement and support mfen ^ vlcn ; ^ ^dpro*dmgre^^ 7^g to care lor the very old. t1 ; honieS. ^£ ^ cliems who prefer to rernairliti * , prov>d "g . s These programs also oiler ^ ^ ^ eTviees and modifying them as a 1 ptoVld ,a jmaie For example, a home health service a0d c day who can identify the rtqu" services, atio 3 Program of home care pto^e ' tl the d*n n. Ca* to meet the needs of the client ^ ^ ^ ri S^m. Funding is person-centere, ^ M,ed m ^ Ce^ered which allows services ^ ^-D l0 >ort movement from insuiu"° ^ lhc ^g-term home health care ptoff» com*u™deVelop. lHc Pattern of need that emerge** pr0grams ^ thoS£ ^Hty of the services available ^dingserv*e ^emphasis tends to shift ftoml • ,,ii-rd to preventing in-, , otUerw.se be ^^^pulTtion (Rasper, The functional independence are °nf r^smmmg relations^ ; > >. ^ ovcr the and (3) SUb h a person ras g abilities and remaimng * o^ d t0 ones changmg way and private meaning ol^ g ^ ^ troports ones ^."^Cta & Bernard, «»nmenl S£ With dignity -,r^ ,si,ilK.noveioa of "keePmg vik & Ytterhus, 2012). In o, de. cSlcd »m solving- rhehomen & rsoiutions sug- tiViStlXof this work suggestth ^ hy Th£ may operate to unele.n ^ & Wactivity, ronment «') fo independent pronie aR, lhcy require ^ ieiv 588 chapter 14 Elderhood (75 Until Death APPLYING THEORY AND RESEARCH The Impact of Gentrif. TO LIFE Gentrification is a process of urban renewal or renovation in which new home owners and developers invest in the rehabilitation of neighborhoods that have been declining or deteriorating due to lack of maintenance and upkeep of the properties. Middle and upper income residents move into areas that have been deteriorating, often displacing poorer residents who have lived in that area for some time.To make investment in new construction and rehabilitation of older housing stock profitable, developers must be able to attract residents who can pay higher rents such as professionals and managers (the urban gentry). Once this process gets under way, landlords have an incentive to evict low-income residents who may have lived in the neighborhood for a long time in favor of more affluent tenants who can afford higher rent (Renn, 2013). Several consequences of gentrification can have a negative impact on the housing options of older adults. First, rental apartments are converted to condominiums that older adults cannot afford. Second, in areas where there is no rent control, the rent rises above the rate that the older person is able to pay. Where there is rent regulation, some landlords use harassment to force out the original residents.Third, properties that have been used as single-room-occupancy hotels are demolished and new structures are built. Single-room-occupancy hotels provide low-cost housing and social support to many oldei adults who live alone. From 1970 to 1982, more than half the single-room-occupancy units in the United States were lost to various urban gentrification projects (Hopper & Hamberg, 1986). A similar study of gentrification in London found a significant displacement of the elderly, with the hidden costs of overcrowding in nation on the Elderly family, friends', or relatives' homes; homelessness; and expanded unmet housing needs (Atkinson, 2000). In addition to reducing access to affordable housing, the disruption in older adults' living arrangements can have health implications due to dispersion of the person's social support network, reduced access to public transportation, and less readily accessible sources of basic goods and services (Centers for Disease Control and Prevention, 2012a). Although gentrification poses threats to housing for the elderly, the alternative of ongoing neglect and decay in urban neighborhoods brings its own risks—especially increased crime, health and safety hazards, and lack of services. Over time, people with more resources leave these neighborhoods, making them vulnerable to continued deterioration. Writing about the process of gentrification in Los Angeles, David Zahniser described it as follows: That, in a nutshell, is the most maddening thing about gentrification—its very duality, the way in which it simultaneously delivers pleasure and pain, miraculous benefits and terrible consequences. As middle-income residents move in, neighborhoods that once heard low-flying helicopters and automatic-weapons fire have found a greater measure of peace. Working-class families who scraped together the money to buy homes in the mid-1990s have happily cashed out, making hundreds of thousands of dollars en route to a five-bedroom home in Fontana, Las Vegas or Phoenix. Those who stay behind, however, frequently find themselves in a neighborhood they don't recognize. And those who rent in a rapidly gentrifying neighborhood discover that they gained physical security while losing economic security, with rents rising steadily and the inventory of reasonably priced homes shrinking (Zahniser, 2006, p. 2) More positive approaches suggest a gradual rehabilitation or redevelopment of urban communities that preserves the identity of the neighborhood but encourages new building and new businesses at a slower rate of growth (Centers for Disease Control and Prevention, 2012a). One idea is to offer developers incentives to include rental or sale units for loW-and moderate- income residents as Part of their design. Some cities have Placed a freeze on the conversions of rental units to condominiums. Others have created community land trusts where residents own the units or homes they live in, but the community owns the land, thus helping to control its use. This strategy is intended to help pr°teC the neighborhood atmosphere an tone that have been created by >ts long-term residents. Critical Thinking Questions Explain why older adults are especially likely to be impacted by gentrification. Why might the increased housing costs be especially difficult for them? 2. Describe the particular stressor that an older adult might face rf.f gentrification results in a loss o long -term residence. 3' Speculate about impact on g Psychosocial development of m ^ to a new neighborhood for Pe0p who are in their 80s or 90s. *• Hypothesize about why the elderly mjght want to remain m rho,\.,---->___» u„mB/ even n their apartment or home, even neighborhood is deteriorating-5- State your opinion about the^ obligations that local g°vernr71e for and developers should assu the housing needs of the elder when older housing stock is renovated or replaced. Developmental Tasks | 589 CASE STUDY Mr. z me folio ">e following case illustrates the importance of psychological at-"fu*s in allowing a person with serious physical problems to play 1 medf»ngtul role in a social setting for the frail elderly. Mr. Zs out-l0ok helps mm majntain nis vitality and express his love of lite. Mr. m. l. z ' ......-'- ^ Fastern European I III 11 llldllllcllll I no raun.;----- ■ Mr- M. L. z is an 89-year-old White male of Eastern Europeari^ ^ lin. He lives in a midsized nursing home in the mo ^ hls daily activities revolve around circulating amo * residents, chattine. olaving cards, reading to ti ^ «a winlin with hls daily activities revolve around circulating amo g ^ '"esidents, chatting, playing cards, reading tt> tn e, vjo|.n ^ things." Most important, Mr. Z carries his old bane ^ ^ |p hl™ and at the drop of a nat will play a tune or d. ^ ^ ^ {q 3 surprisinelv strons. clear, melodic voice. He c ^ *o least en- 'm and at the drop of a nat will play a tune or orea*. ^surprisingly strong, clear, melodic voice. He claims to be able to rSn§ songs in any one of seven languages, and with the least engagement will try out several for anyone who will listen. fa ^ 2 is small (5' 3"), frail looking, and completely bald. He has scars and wears extremely thick-lensed glasses. He seems ,° be known and well liked by practically all residents and staff or meLfa^ility in which he resides, and by many visitors there as wet , He recalls a colorful history. He "escaped" his homeland at the c1er age of 16 to avoid compulsory military service and led o There he was inducted into the army, and was subsequent « to duty in Siberia, where he lived for about 6 years Ate. tour of duty in a border patrol he deserted he made h R acr°ss Europe, and eventually came to the United States. Here t0°k odd jobs, educated himself, and in time got into show ,bnU!'ness"; he became a vaudeville prompter. In time his.cmtects " ^tertainment took him around the world. Yet time VpaHe tells of marrying a woman with whom he lived for a (most £rs- ^ey had no children and she died some 15 JjwagJ. 2?her death, he began to experience a series of physic al dtf >e,An operatfon fic^*™£^^ i(*8iad lots of vegetables; he loves fish c,1eerfu, 6 a." his troubles, Mr. Z maintains what is apparently a S°es his'h ht,rT"St'C Wew of "fe and circumstances, while he pur-their spirit V °f enerS^ically helping his fellow residents keep *tartteiiPrdS f"llng a very important role in his nursing home as a °nd oHCfrpt from 4?% a«c/ /./fe.'/i/? introduction to Gerontol-in 33-34 r ' by A- N- Schwartz, C. L. Snyder, and J. A. Peterson, 0 by permission of the publisher. CASE ANALYSIS Using What You Know 1. Imagine that you were having lunch with Mr. Z. What questions would you want to ask him? 2. Summarize the physical challenges of aging with which Mr. Z must cope. 3. Based on your reading, explain why Mr. Z might be living in a nursing home. 4. Describe Mr. Z's psychohistorical perspective. What insights does he have about history, time, and self-awareness? 5. Analyze the unique, creative adaptations that characterize Mr. Z's story. 6. Evaluate how well the nursing home is optimizing Mr. z's functioning. Gender-Role Definitions The way in which very old adults view masculinity and femi ■ ninity is yet another aspect of traveling uncharted territory. How do the very old define gender roles? i low docs gender influence behavior? Do very old adults make the same distinctions as college-age individuals about the behaviors that are appropriate or desirable for men and women? These questions remain to be answered. Evaluating the Concept of Gender-Role Convergence. The idea of gender-role convergence suggests a transformation of gender-role orientation during midlife. According to this theoretical perspective, men become more nurturant and more concerned with social relationships. Women become more assertive and concerned with independence and achievement. As a result, men and women become more androgynous and, in that sense, more similar in gender orientation during later life (Gutmann, I 987). The extent to which men and women become more similar in outlook and behavior in later adulthood and elderhood is a subject ol controversy. Unfortunately, lew data from longitudinal or cohort sequential studies are available to address this topic. Cross-sectional data collected from mm' and women across a wide age span from early adulthood to elderhood have focused on men's and women's endorsement ol affiliative and instrumental values. Men and women appear to be similar in their affiliative values—that is, the values placed on helping, or pleasing others, reflected in the amount of time they spend and the degree ol .satisfaction they achieve in such actions. Al each age, men are more invested than women in instrumental values- -that is, the values placed on doing things that arc challenging, reflected in the amount of time they spend and the degree of satisfaction they achieve in such actions. However, the youngest age groups value instrumentality more highly and devote more time to it than the oldest age group. Tints, gender differences in instrumentality persist, but instrumentality becomes some- "^TmVorumt for older men and women. Affiliative is equally important for men and women a, both ^(Futa fit Herzog. 1991). 590 j CHAPTER n Elderhood (75 Until Death) tereotypes that are applied to aging men and women reflect similar patterns. College students and older adults (with a mean age ol 70) were asked to generate characteristics in response to one of lour target stimuli: a 35-year-old man a 35-year-old woman, a 65-year-old man, and a 65-year-old woman (Kite, Deaux, Sr Miele, 1991). Age stereotypes were more prevalent than gender stereotypes. The attributes drat were used to characterize older men and women were similar and distinct from the attributes used to characterize younger men and women. In general, the older target people were evaluated more negatively by the younger participants, but not as negatively by the older participants. These negative judgments included unattractive physical qualities as well as irritable and depressed personality qualities. Moreover, younger participants were more likely to characterize both male and female older target people as lacking in instrumental trails, such as achievement orientation and self-confidence. However, they did not view older target people as lacking in afliliative traits, such as caring about others or being kind or generous. Thus, the gender-role convergence that has been hypothesized as taking place with advanced age is reflected in the stereotypes that younger people apply to older adults. Gender-role convergence, where it is observed, may be clue to changing circumstances rather than to a normative pattern ol development in later life, kor example, many older women experience a transition from living with their husbands to living alone alter age 75. This change is linked to new demands lor independence, sell-reliance, and agency. Women who are able to meet these challenges by develop-in;, independent living skills, making effective use of social supports and community resources, and initiating new relationships are likely to experience a heightened sense of well being. For many older married couples, the physical effects ol aging bring new needs lor assistance in some ol the tasks of daily living. Because mm usually marry younger women, they are more likely to require the assistance of their wives m tlľ later years of marriage, thus shilling the balance of power and increasing their sense ol dependency, litis may be especially true when husbands retire while their wives continue to work; when husbands can no longer drive and mu ., depend on their wives lor transportation; or when, ,!,„. ,,, health constraints, husbands are restricted from per-rormine the types ol household tasks that once were their domain, such as mowing the grass, shoveling snow, repair-jn„ the hour', or Othei tasks requiring muscle strength and endurance.' )n the other hand, among adults ol 75 years and older more women than men have difficulties with mobility and require assistance in the tasks of independent living. Thus, health and fitness more than gender may guide the nature of dyadic interactions among older couples. As men and women become more equal with respect to power and resources in their marital relationship, there may be fewer clear-cut gender expectations. Still, to the extent that Sender-roIe disf ,a,C'Uf!s K*y be JS"5 he'P ^bdizc a relationship, older hC:r Kktionships h, 1° make d!'am«tc changes to the way Rnfv, ' VL mi ^ucturcd (Silver, 2003). oJder married cou^h^u^31^ rcmam important among '°yed a cI°se, sexui , maJoril>/ "couples who haveen-" faction lnm Y aCUVe Telationship report little change ,!ent w*ys o/'exn 'f ° 60 IO 85 Some couples explore dil-,? '"S rePor, a mP0" n°n§ "*«al pleasure in later life, and ne,rl°vemakin ' ,c'a«'d, sexually satisfying quality * ^nsions o/CL "'"^rnherg's (1988) model of the three dl h*g-kstir,J 'al'onsh,'Ps fee chapter 11, Early Adult-' e In nature ernnh "aSes (enel to be more compamon-SIOn- 'n >h,s mL,t?nK imimacy and eommitment over ens«yand quaIitv ' lovemaking may [akc m a different in-f£rlife eonfirms, ^ Curre™ research on sexmW* n!'0rn s^al exp °lder ^ults have sexual needs, hene& at,onaI survey 0f ?]' ^ are ab,e to be sexually active. A lan haJf were se'„ n 3ges 60 and older found that more COUrse. oral sex »Z fy 3Ctive' mining that they had inter-* mo"'h (Dunn&r ,?le,C0L"^, or masturbated at least once actavity ded. j^tlcr, 2000). This study found that sexual 7,r were sti|T 3ge' h* that 20% to 25% of those to f3ter satis/act(0 ' SexLla"y active. Older couples may find l,lgand earessin!" 'Vn'ima[e contact, such as m l nt:nci'n« seXUa, J JP^ntation with new ways of * 'SS Suent P0)r m a,ion as Scnkal intercourse becomes "°nvergence, men ^g al°ng Wi£h the idea of gender-■** reXUa! behavfc! become more similar in ;)ob^Bauera;oC Inharmonious in their love***** ' figure 14.13). today's cohort of older men and women t ^f [heir "'^ to many of the traditional gender-role Standar ^ ^ torical era. For example, older women are U g ' that the only kinds of relationships that are p0^01*^ men and women are romantic or courtship oK1 Pew very old women have friendships with alsQ beca ^ partly because lew older men are available, b , most older women have no models for indep-ship relationships wi,h men. During their eat forj]J^ adult years, their friendships with men were ^ while they were part of a couple or mediated , ^ ^ c situation, such as a work setting. Many rae ^ rent elderhood cohort also behave in accOjV gender-role standards of their young adulth ^ women far outnumber men at advanced ages- ^gb to prefer to remarry rather than play the fieRl'' 11 f< have become a scarce and valuable commpa'^ 2 m0n°gamy guides be les these men's behave • t0 ffa% motivated to remarry by a desire to eont lal me ^ Prt">' to widowhood. The more oc ^ marn R le*> likely they were to express UK q£ s0L -f d women who had compa^ , ,t#n frnmt,,.... , ........tu, disinter have s oi remand »\tau'' does ,« require the responses kind of UMBO* , sermons 60 ' ...!« Older .duUs com^e.0..« 2............»«• .vnallv unattractive, (Crooks & Bauer, -e the^dakultchildre^ Slaf' , hu- does not always resui mStituuonal set-k»0Wl, ge Hlly among health ca.e and ^ t -0,1,1 regulations, pc 1 among resi-dnes, the >"bU V...... nf „er.mu.ng sexual activu)........^ ^ * '.kely they were to »1»—^ leVelS '~ e. lld women who had compar in rettia gen- , tspe^"/ re2Ulations, person." —..... ** friends were equally J*^**e we b«* ^ .id- ^ (hc msumuon regu ^ ^n est . This research suggests that he:? ^ a, ^ lhan ^ problems^ g morc negat.vc auuudc der differences in motivations to » boUgb mo ^ ,11rt °*W needs to be revised. Ftf^ ^ttonM ' 5b* *icia! . revised- ilic rerauu" ,]ien socw nen arelnterested in n^^'^rest. Se^. ' about ]{^ of men do not express this ^ wot^^p. >Pon systems arc comparable. ^ntrc ^ ta >% likely to reject the idea ol » ^ l0 wb' °nt limitation of this research was „.ri sexualuy among l0waiC se 592 i CHAPTER 14 Elderhood (75 Until Death) adult women are in the workplace, they have more experience with male colleagues. Also, changing sexual norms have already led many more adults to experience nonmarital sexual relationships. A growing openness about homosexual relationships may reduce some of the stigma against forming same-sex bonds in later life. Acceptance ol new sexual relationships in later life is more likely because many adults will have experienced a larger number of sexual relationships in their earlier years of adulthood. The high divorce rale since the mid-1970s means that in the future more women will have had the experience of developing a single lifestyle that includes a network of both male and female friends. As the value of intimacy for health and well-being is more fully recognized, we may expect future groups of older adults to be more comfortable about forming homosexual as well as heterosexual intimate relationships. FURTHER REFLECTION: Imagine thai you are now 85 years old. Describe the kind of life you hope to be living. What kind of living arrangement, social relationships, and activities would yon like to have? What concerns for physical health, safely, intellectual slim illation, and social interaction will you have then? flow will yon design you r life structure to support your needs in these domains? The Psychosocial Crisis: immortality versus Extinction , OBJECTIVE 5. Define and explain the psychosocial crisis of immortality versus extinction, the central process of social support, the prime adaptive ego quality of confidence, and the core pathology of diffidence. By the end of later adulthood, most people have developed a point of view about death. Although they may continue to experience anxiety about their impending, death, they have found the i ourage to confront their fears and overcome them. II oldei adult i have achieved integrity, they believe that their life ha . mad'' sen te. This amplifies their confidence about tin- choices they have made and the goals they have achieved williixii despair Dver the failures, missed opportunities, or i,a,|mt ani-, that may have occurred. 1 bus armed, elders can a(, ept the end o( life and view it as a natural pan of the life .pan. Hay are capable of distilling wisdom from the events o| iheir lives, including their successes and mistakes. I lowever, elders are faced with a new challenge—a conflict between the acceptance ol death and the intensifying hope for immortality. I laving lived longer than their cohort ol friends, family members, and even, in some cases, their children, elders struggle to Imd meaning in their survival. All of us lace a certain disbelief about our own mortality Although we know that death is a certainty, an element of human thought prevents us from facing the full rcalizat' of death; we continue to hope for immortality This quay may be adaptive in that people who have a sense ol ^ cope with the reality of death' belter than those who do (Kesebir, 201 I). immortality Elders have a unique appreciation of time. They reC°2' that there is a finite amount of future time until 'he"( C/tnP- : that be- as well as an unlimited transcendental future time • . gms with their death and extends onward into infinity > ^ SrZimbardo, 1996; Zimbardo & Boyd, 2008). They t*B . see themselves as links in a long, fluid chain of ^T^j, --,w u.,i\o ill a LULlg, I1U1>-I v-.'v,--- - f thi biological growth and change. The positive pole 0' nCe 0-is a confidence in the continuity of life, a transc ^ jnl. death through the development ol a symbolic se ^ ^ mortality. The achievement of this perspective- ^^ include the incorporation of transcendental S03 ^ froi" uniting with loved ones after death or being rc e: ^ the limitations of an aging body, may be accomp ^ ^g, sentiments of joy which contribute to feelings 0 flexibility, and acceptance of the challenges of agm^.^d A psychosocial sense of immortality may ^ we e*' and expressed in many ways (Lilton, L973J- opC niaY plore live possible paths toward immortality- hl^lion an' live on through ones children, sensing a conn 0| ..hi,------- ■ - " and u"- -•■•««fcii uiics cnneiren, sensing » !"!?™.t0 thc lulurc thrDUSh one's lile ""Jetten*1 one's offspring. This type of immortality can - , t0 include devotion to one's country, social organs groups, or humankind. .,.,,) gpud im moria1 s Second, one may believe in tin afterlife, an -°r a spiritual plane of existence that extends bef^° {C\i-ologtcal life (pereira, Falsca> de :>ii Saraiva. 201.2). gions espouse the concept of a state of harmony *,U h)y life-»'ces, so that alter death, one endures beyond this ^ g „ ■ 1 ~- >-"iu-epi oi a stale oi in" S° that after death, one endures beyoi.u . igure 14.14) Among many indigenous people: "edlmk between the living and the dead , ther ions' ed burii on - a ,esf* a bin''1' l,1C ^ the living to protect and respect the grounds and a responsibility on the part of .he dead 0 J ,00k »J*r the spiritual well-being of the living. J* fl* illustrated in tu u______ . & . j rwrsityn . me spiritual well-being ol the living' ; the Human Development and Diversity v of Nan™ u......a_____r....-ri,„ir Ancestors .....;csK,rs'^.re-Responsibility of Native Hawaiians for Their An At Third, one may achieve a sense of immorta 1, ^ pe:V alive achievements and their impact on other ■ ^ 0| p" find comfort in believing thai they are part °1' ^ ^0^. live influences on the lives of others. This sense 9a is linked to the achievement of generativity 'n pr0vi^' l0 h«od. Adults who have made a commitment to ^ \W quality of life for others during, middle adultn0 ^0o ■ see evidence of this effort by the lime they re* Perhaps it was only ,„ the later years ol ^X^& s 1 saw the results of my labors in the unto ^ of my patients—that once again 1 app«cia ?0jl) value of my link ln the chain of life- (Youn8'' The Psychosocial Crisis Immortality Versus Extinction 593 HUMAN DEVELOPMENTANDD.VERS.TY The Responsibility of Native Hawaiians for Their Ancestors' Remains ne following narrative describes the Cl"isis of immortality versus extinction ln the context of the desecration of a native Hawaiian burial site. In fighting to stop the destruction, those involved were reminded of the commitment th)at the living have for the care and pr°tection of the burial grounds of their ancestors: Hawai'i Nei was born December 1988 from the kaumah a (heaviness) and aokanaka 'enlightenment) caused by the archaeological disinterment of over 1,100 ancestral Native Hawaiians from Honokahua, Maui.The ancestral remains were removed over the protests of the Native Hawaiian community in order to build the Ritz Carlton H°tel.The desecration was topped following a 24-hour vigil at the State Capital. Governor John Waihe'e, a Native Hawaiian, approved of a settlement that returned the ancestral remains to their one hanau (birth sands), s°t aside the reburial site in Perpetuity, and moved the h°tel inland and away from the ancestral resting place. Ir> one sense Honokahua ^presents balance for from this tragedy came enlightenment: the realization by living Native hawaiians that we were responsible for the care and Protection of our ancestors and that cultural protocols needed to be releamed and laws effectively changed to create the empowerment necessary to carry out this important and time-hnnored responsibility to malama (take care) and kupale [protect) our ancestors. Hui Malama I Na Kupuna O Hawai'i Nei members have trained under the direction of Edward and Pualani Kanahele of Hilo in traditional protocols relating to the care of na iwi kupuna (ancestral remainsfThese commitments were undertaken as a form of aloha and respect for our own families, ancestors, parents, and children. Hui Malama I Na Kupuna O Hawai'i Nei has been taught by the Kanahele family about the importance of pule {prayer) necessary to ho'olohe (listen) to the calling of our ancestors.Through pule we request the assistance of ke akua and our ancestors to provide us with the tools necessary to conduct our work: E homai ka ike, e homai ka ikaika, e homai ka akamai, e homai ka maopop o pono, e homai ka 'ike papalua, e homai ka man a. (Grant us knowledge, grant us strength, grant us intelligence, grant us righteous understanding, grant us visions and avenues of communication, grant us mana.) Moreover, we have been taught that the relationship between our ancestors and ourselves is one of interdependence—as the living, we have a kuleana (responsibility) to care for our kupuna (ancestors). In turn, our ancestors respond by protecting us on the spiritual side. Hence, one side cannot completely exist without the other. Source: Pell (2002), http://huimalama. tripod.com/ Critical Thinking Questions 1. Describe the belief system that connects native Hawaiians and their ancestors. How does this belief system contribute to the resolution of the psychosocial crisis of immortality versus extinction? 2. Predict how the sense of interdependence between the living and the dead might influence the day-to-day behavior of native Hawaiians. 3. Select a culture of interest to you. Investigate and describe the relationship of the living to their ancestors in this culture. Summarize the beliefs, rituals, and actions that reflect this relationship. 4. Analyze the trends of modernization that may explain why Hawaiians have lost touch with the traditional practices associated with the care of ancestral remains. Propose what may be gained by reviving these traditions. file b() C'eatlj u Delvveen arj individual and community makes proverb advises that you live as a''e in ITleone knows your name. The more embedded you ^Cgreatg' Corn,nLI)'ilyand the more lives you have touched, ^°unh' t'1(" S<"SC °' conlmu',y ortnutseendencc. "1Cchiii ' may develop inc ttotion of participation in aUd 0n ? nature. In death, one's body mums to the earth - c"crgy is |j,-OUg],| /or(|, jn a new form. Fifth, one may achieve a sense of immortality through whal Lidon (1073) described as experiential transcendence: This state is characterized by extraordinary psychic unity and perceptual intensity. ISui there also occurs ... a process of symbolic reordering.... Experiential transcendence includes a feeling of ... "continuous present" that can be equated with eternity or with 594 J CHAPTER 14 Elderhood (75 Until Death) figure 14.14 Through prayer and inspiration, this minister shams her raith and sense of immortality with her congregation "mythical time." This continuous present is perceived as not only 'here and now" but as inseparable From past and future, (p. 10) The notion ol cosmic transcendence has been devel-[urther in the writings of Lars Tornstam, a Swedish ttologist, who writes about feelings ol cosmic com-linn with the spirit ol the universe, and a redefinition ol time, space, life, and death (Tornstam, 2005). This expression ol immortality is independent of religion, offspring, or creative achievement. It is an insight derived I rom ......ii< in . ol rapture or ecstasy in which all that one lenses is the powei ol the moment. In these experiences, the duality ol life and death dissolve, and what remains is continuous being. ope ge r< Extinction I he negative pole ol the psychosocial crisis of elderhood is a sense ol being bound by die limits of ones own life history. In place of a belief in continuous existence and transformation one views the end ol life as an end to molion, allachmeiil and change. Instead ol (an 11 in the ideas of connection and continuity, one experiences a fear of extinction—a fear that one's life and its end amount to nothing. Eriksons advice on coping with aging concerns responding to loss and de with diminished capacities (see the Applying Theory a ^ Research to Life box Erikson on Coping with Aging)- not difficult to imagine that as a person reflects on the ^ losses encountered nvcr i lr.nn lil'p ihere will be Per and strug- losses encountered over a long life, there will when ii seems that all the effort, striving, hoping- -■- t ,'d 1101 amou|H to much. In the process of resolving ' Psychosocial crisis, it is to be expected that people will have « 'east momentary thoughts that there is nothing more; thai end B truly an end. The following quotations from a study ol very old m*1 ^ggest the range in sentimem about immortality and extinc-'°n Rosenfeld, 1978) p. 10). About 28% of the adults"; He study were described as having low morale and *•* statements such as "I feel rm a forgotten man. I don't eX*« anymore.... i don't feel old. I'm just living out my d hT l% WEre Sl0ic but n<* very positive about their co* minrU kn°W y°u'K «e"jng old. You have to put 11*and take „ as it comes You can', get out of it t gracefully." Almost half found their lives full and 8° h°me Wilh mV ™p overflowing. There are so n*»J -:P|Xmun,t^ to do things for people. These are the tapP* days ol my life." Conditions in long-term ^unuiuons in long-term care facilities may c~~- jn the sense of extinction for some elders. Imagine WJ , lul'5- facility where the staff consistently mistreats older a -V ------- -dniion anu ne one study, incidents of physical abuse, LntlmiOW • ggjjig gleet were reported by 44% of nursing care resl tinent °f a victim of violence or being exposed to violent ^ Ol others in a selling where a person has no way 1° ^ cle5pair punish the abuser can certainly produce feeling Ql2). and withdrawal (National Center on Elder Abuse,^ ^ The possibility of ending one's life with a sens ^ lion is reflected in the public health concern »' [icdlM' among the elderly. Data from the World HcaUh btt ^ ^.^e nual provide a basis for describing the incidence ^ ^ for men and women in the age groups from 0 ]3) U& 75 years and older (World Health Organization, _e tyit commit suicide at higher rales :nat la£g« as tiQnal suicS 2 a'"e Substantial- Korea h;'s the h'B pi^aT^ haIf the —^ are ^Utea wilh suS r Xl °,der' In ,!"' analysis ol factors formins a hi "lgS °f ^aninglessness were ide^ ScSr teh0Socia] ««« for late-life suicide £*J , cuS ner ^ InJapan' « had been viewed thm<: «1 SPomTiVe as » expression of courage and in^ ;un ; owever, rccent increases in the rate o^ >ldei ^ults have become a cause for concern^,. j of older ft*"? rural lapanese society have led to a reduced valuing The ilV r5en* members and less extended family support. .--are less able to accept these changes which undercut V^tf. 0 Purpose and meaning (Waianabe, I iascgawa, & ^ ol L996). Without appropriate social support, and in ^ The Central Process: Social Support 595 THEORY AND RESEARCH TO LIFE APPLYING THEORY Mm Erikson on Coping with Aging The Eriksons' advice (Erikson et al-. 1986, pp. 332-333) suggests tne achievement of experiential transcendence: With aging, there are inevitably constant losses-losses of those very close, and friends near and rar.Those who have been rich in intimacy also have the most to lose. Recollection is one form of captation, but the effort skillfully to form new relationships is adaptive and more rewarding. Old age is necessarily a time of relinquishing-of giving up old friends, old ro|es, earlier work that was once meaningful, and even possessions that belong to a previous stage of life and are now an impediment to the resiliency and freedom that Seem to be requisite for adapting to the unknown challenges that determine the final stage of life-Trust in interdependence. G've and accept help when it is needed. Old Oedipus well knew that the aged sometimes need three legs; pride can be an asset but not a cane. When frailty takes over, dependence is appropriate, and one has no choice but to trust in the compassion of others and be consistently surprised at how faithful some caretakers can be. Much living, however, can teach us only how little is known. Accept that essential "not-knowingness" of childhood and with it also that playful curiosity. Growing old can be an interesting adventure and is certainly full of surprises. One is reminded here of the image Hindu philosophy uses to describe the final letting go—that of merely being. The mother cat picks up in her mouth the kitten, which completely collapses every tension and hangs limp and infinitely trusting in the maternal benevolence.The kitten responds instinctively. We human beings require at least a whole lifetime of practice to do this. Source: From Vital Involvement in Old Ago, by E. H. Erikson, J. M. Erikson, and II. Q. Kivnick (1986), pp. 332-333. Critical Thinking Questions 1. Critically evaluate the advice provided by Erikson. Do you think it would be good advice to give to older adults to help them cope with the challenges of aging?What advice would you offer in its place? 2. Given the full course of psychosocial development, speculate about why it may be especially difficult for the elderly to accept help and depend upon others when they need it. What lessons from earlier stages of life might prepare a person to do this? 3. Erikson suggests adopting an outlook of playful "not-knowingness" and adventure. Summarize the cultural, religious and personal factors that might help a person attain this view of elderhood. 4. Read more about Erik Erikson. What can you find out about how well he was able to accept this advice in the last years of his life? ^anlia„y reduced |)hyyita| or psychological resources, a sig- number of the very old end thcM-own lives. H Evidence on the outlook of the community-based popu* °,n °f the United States suggests that relatively lew h experience a level o. discouragement that is n p ?** sense of extinction. Among .hose ages V5 and0 der N than 6% report pervasive feelings ol worthy or ^lessness (National Center lor Health Statics 2C0. A £uu°n about these data is that elders may be reluctant Lp0rt feelings of discouragement or hopelessness. Central Process: s°cial support • . social expe and interconnectedness or web of social relationships in which a person is embedded, the .strength ol those lies, the frequency ol contact, and the extent to which the support system is perceived as helpful and caring (Beige-man, Plomin, Pedersen, McClearn, & Nesselroade, 1990). [t is commonly divided into two different but complementary categories: socioemotional support, which refers lo expressions ol affection, respect, and esteem, and instrumental support, which refers to direct assistance, in eluding help wiih chores, medical care, or transportation, both types of social support—but especially socioemotional support—contribute to maintaining well-being and fostering the possibility ol transcending the physical limitations that accompany aging (Rowe & Kahn, I 998). SUppOT t has been define t0 believe d «• they are c as thai ri--ed for s«cial s e«ces that lead people to beU«* ^ 0 n ^dWed, esteemed and valued, a! of Benefits of social support Social support plays a direct role The S°cial support is a broad term being. ing life satisfaction even when a per a specific stre sslul situation (Cow et son is not lac-u\, 2007; White, communication 596 ! chapter 14 Elderhood !75 Until Death) Philoogene, Fine & Sinha, 2009). Because social support involves meaningful social relationships, it reduces isolation. People who have intimate companions in later life have higher levels of life satisfaction. They feel valued and valuable. This kind of social support is likely to be most appreciated when it comes from friends and neighbors—members ol the community who are not bound by familial obligation to care about the person, but who do so anyway. The presence ol caring, familiar people provides a flow of affection, information, advice, transportation, and assistance with meals and daily activities, finances, and health care—all critical resources. The presence ol a support system tends to reduce the impact ol stressors and protect people from some of their negative consequences, especially serious illnesses and depression (Krause, 2006). Social integration and membership in a meaningful social support network are associated with increased longevity. A high level of social integration is associated with lower mortality rates (Cherry, Walker, Brown et ah, 20 I 3: Rowe & Kahn, 1997). The support system often serves to encourage an older person to maintain health care practices and to seek medical attention when it is needed. Members of the immediate family, close relatives, and friends provide direct care during times ol grave illness or loss, encouraging die older person to cope with difficulties and to remain hopeful. Elders are likely to experience declines in physical stamina. They may also have limited financial resources. In order to transcend the limitations of their daily living situations, elders must be convinced that they are embedded in a network of social relationships in which they are valued. But their value cannot be based solely on a physical exchange of goods and services. Rather, it must be lounded on an appreciation ol the persons dignity and a history of reciprocal caring (Figure L4.15). The Dynamics of Social Support The benefits ol receiving social support can be diminished if the recipients adhere to a strong cultural norm lor reciprocity. The norm of reciprocity implies that you are obligated to return in lull value what you receive: "One good turn deserves another." People want and expect to be able to give about the same as or more than they receive. What is given does not have io be identical to what is received, but it has to be perceived as having, equal worth. Being in someone's debt may be considered stressful and shameful. In a study of Japanese American elderly people, receiving material support from their family was associated with higher levels ol depression ami lev, salislaclioii in lile, '-specially lor those who had very traditional values aboul reciprocity. The general principle of trying to mobilize social suppofl to enhance the functioning of the very old has to be modified to include sensitivity to the context and meaning of that support (Nemoto, 1998). Most elders continue to see themselves as involved in a reciprocal, supportive relationship with their friends, heelings of usefulness and competence continue to be important correlates of well-being in later life. Older adults are especially ith figure 14.15 social support can contribute to imprc^e||5 S°oa] relationships can include both positive W :;,S-Wilhil,---e,al aetwork positive ^ope: delude enjoying shared activities, confiding ^nes, or asking for help when one i ill. Keg*** privacy nu' ^lude ^ing taken advantage of, h«v^ graded, or being insulted. Sometimes, th«s lbe sources of both positive and negative to* one5 ' f hav>"& „o-'eof' ,VeP* tio'15' The Central Process: Social Support 597 ()1hcrs are closely linked to friends and neighbors, and others m , , , 11 r-vMirncv of positive exchanges r closest ties in church or community organizations. N sut-pnstngly, the overall fr«jW ° ^ adults Wtote* ^ network com|)oncnl ls lelated to lower levels o( depicssion what is more, c /i Pxamr>le a sibling might experience the elf ects of negative socmen^ ^ contribute ^fii^ pirovtle ^lationship-lor example, when they havana£ ^ provlde ^"^^SmL. or health-related advice, their adul, child-they can bulfert « - u ^ ^ «^^Pj£ ^have no surviving children or sib-Positive interactions with anothea me mix l998). Elders *b tlicir ,ivcs in isolation. Work-for example, a friend or -P"*^ people in .hen *^ al, able lH p,.eservc . diverse social net-Many older adults are selective bout he p ^ ln con sb d os«w )nakc (hc nlost use social network, striving to interact p inV sleps work are more ^ and experience the higlv who engage in harmonious For exam- oi (Aymonutci el al., 2001; Bosworth & prevent conflict in the relationships uhcy^v 1997; Litwin & Shiovitz-Ezra, 2011). P'e, they impose certain constrain * others* privacy, *Mi , adu|lS( a.|igious participation provides an not criticizing someone in public, resj , nega. <- - f jai supPort. Older adults are more and keepings confidence. These stratus hch, ^ «*^^f llts J describe themselves as reli- Uve interactions and maximize the sa g of weak- ^ « ' beliefe and behavior. Mary, who at age 80 has «1 their relationships. These strategies a,e ^ ^ mcan. gl0US n ^. hc). husbantK and |*ss or privity, but a deliberate attemp ^ expen ^ g)WS and rp(riws emotional support lnghil relationships and avoid the neg tici < B ^th interpersonal conflict (Sorkin& Rook, 201- ^ugh her faith. 1 I always have a lot of Faith. The good Lord has always _.....,,„1-, io (to on. 1 was raised to believe The social support Net** °l course heme an integral par _ ,,ul On wc»— ^ temdoes course, being an integral part of a so^ ^he not begin in later life. It has its oiW* for "Of be ■ ' sUpport n o/ a mutual relationship with a caregiver '^enc LSt6ms are ex!ended in childhood and early ado ea'''y and 1,OU^'1 ic'cno'fication with a peer group, and in ai'kl rei C. niic'cHe adulthood through marriage, chilclrearinj:, life, /antU!°nShlps Wl111 coworkers and adult friends. In later ciaj s v Members are usually the primary sources of so-f'he qijg?.0rt' ^F^ciafly one's spouse, children, and siblings, at) agj ^ ,ly °' the relationship between an adult child and SUPporf ?arenl nas a 'ong l^slory. Clearly, the nature of thr ilc'u'( ch'nat a" aging Parent is a'-''c 10 receive oran °f cloSe ' "S w'"in^T t0 Providc '-s influenced by the feelings childr Css anc' connection (hat were fashioned during the the pa ar'ng Process and also by the child's relationship to huh "ts during eariy adu,thood years' sOciai 6 Uruted States, age is a predictor of the size of the sUpp0n.U*5*)Orl network. Younger people have larger social Variet ne'Wor,'omen alon must tionsh networks than cio uiu_. -/of reasons For elder women, the likeui«.....- is high. After the death of a spouse, men and women reahgn their social support systems from among itla-^PMha, include their adult children, friends, relatives S^ors, and new acquaintances in order to satisfy the •"!N br interaction and companionship. In a study ol so oal f] U,«>nsli.Ps foll0wing widowhood, women dCath' however, contrary to expectations, efforts u o h y -..dd acquaintances or forming new '~.,.-/.-ssion or "üs nc( Wcver, contrary to cxpcclauu,... eitdsh' *< '3y renewing old acquaintances or forming iK .. '0ľ,eljne .'!')!> c,,ci no1 belp to reduce /cc/ing.s of depression or Bide 'CVcn 2 years after the Í()S-S (Zc"d & Rook' 2()()4)- ^herea^ er tne comPosaion oi their social networks. ' s°me ciders rely heavily on close lamily members. through her ian11. 1 always have a lot ol faith. The good Lord has always given me the strength to go on. 1 was raised to believe and pray when I have problems. I go to Mass every Sunday, and we have other special days when we go to Mass. I'm a Eucharistic minister. Clod makes me do things to feel better—I serve people and God. I go to buildings to give communion to people who can't get out. (Rowe & Kahn, 1998, p. 164) Members ol religious congregations are likely to provide one another with both emotional and instrumental social support. The place ol religion in the lives of the very old is especially significant for African Americans, who are more likely than European Americans to attend religious services regularly, even al advanced ages. They are also more \\kc\y to describe themselves as very religious—a characterization that reflects the frequency ol their private prayer, [\)cii si\oni\ emolional commitment, and their reading of religious material. Religious involvement among elderly African Americans is not predicted by income or education. ()ver time, elders who are active in their religious communities give and receive increasing amounts ol emolional support to one another and express increased satisfaction from these church-based relationships (I layward &r Krause, 201 3). Ethnic identity itsell may also become an important vehicle for social support in later life. It can provide a variety of sources ol nonfamilial support, from a loose network of associations to membership in formal clubs and organizations. Members ol an ethnic group may feel a strong sense of community as a result ol their shared exposure to past discrimination, a realization oi common concerns, and a sense of responsibility to preserve some of the authenticity of their ethnic identity for future generations. Participation in such a support network may be another vehicle for contributing wisdom gained through life experiences to those who will follow. Insofar as members of ethnic groups have 598 chapter 14 Elderhood (75 Until Death) felt somewhat marginal in the larger society in the past, their mutual support in later life may prelect them from some of the negative stereotypes that the society imposes on the very old. involvement in a social support system can be viewed as an essential ingredient in the achievement ol a sense ol immortality. The social support system confirms the value of elders, providing direct evidence ol their positive impact on others and a sense of embeddedness in their social communities. The social support system ol elders usually includes adult children. Positive interactions with them contribute to the sense ol living on through one's offspring and their descendants. Interactions with members ol the social support system—especially those marked by feelings of warmth, earing, and celebration- -may be moments of experiential transcendence for elders. They Feel the fullness and joy of existence that transcend physical and material barriers. The Prime Adaptive Ego Quality and the Core Pathology Confidence In this discussion, confidence refers to a conscious trust in oneself and an assurance about the meaningfulness of life. In this definition, one finds the earliest psychosocial crisis of trust versus mistrust integrated with the crisis of integrity versus despair. In elderhood, after a lifetime of lacing challenges and experiencing losses and gains, one has a new beliel in the validity of one's intuition, a trust in ones world-view, and a continued beliel in one's capacity to participate in the world on one's own terms. Confidence is sustained by a stable, supportive social network (Krause, 2007; bang, Featherman, & Nesselroade, L997). older adults who Feel they are able lo engage in the activities they enjoy and to interact with people they value are also more likely lo believe thai they can adapt to the challenges they lace. As a result of their confidence, they are less disrupted by stressful events and more hopeful about being able lo find successful solution , in the face ol negative events (Pushkar, Arbuckle, Conway, < '.iiaik.rt.on, &t Maag, 1997). Physical health and age, per se, are not the best predictors ol confidence. I )ne's perceptions of physical health problems and how one sees onesell iii comparison lo others may be more important predictors ol confidence than any objective measure ol health status. Some people view themselves as more impaired and dependent than they actually are; others, who may be suffering from serious illnesses, continue to view their situation with optimism (Ryff, 1095). Similarly, ones perception of the adequacy ol social support and its appropriateness in response to one's needs is more important to a sense of confidence than the financial value of ihe resources exchanged (Davey & Eggebeen, 1008). Over the course of the life span psychosocial theory Indicts that each individual will confront issues related to lne negative poles of the psychosocial crisis of each stage. We argue that finding ways lo integrate the negative pole ol each stage into an overall positive worldview strengthens and humanizes ones character. Encounters with each negative pole provide a deeper sense of empathy for the sul-le»ng ol others and a more profound appreciation lor «e courage thai ii takes to live out erne's life with an open, generous, hopeful outlook. Confidence emerges not because o ■ auenceof posi- a lile of one success alter the next, but out of a seq Struggles in which creative energy is required to find active balance between positive and negative forces (E .1- M., 1088). /con, of over-■ factors Diffidence whSfCnCe,referS t0 an in'>bility io act because 8 11 is COnside^ one of the basic factor* eo^ffiP^^y C,Lsorders (Livesley, Jackson, SrSchro-1 902). Diffidence is evidenced by an unusual m*** oldifficulty in making daily decisions without advice f '<-' surane from others, great reluctance in underlay Projects; or becoming involved in activities because ol la J h ^uh in ihe fear of being alone (American Psych*'* Association, I9CJ4) h Diffidence is likely to be associa.ed with hopd**** Am ng the elderly, hopelessness is experienced as a «jf bout hPeCtanCy ab°UI the fut»re and a sense of fcog ^out having an impact on impending events. The com apher. '^ofcon" anresul1 from increased dependency Pon, o ' UC t0 P^ical illness, loss ol soc.a can be 1 I action in the quality of lift! f * buildt:^" of continuous process of ego nation of hopelessness and depression are stron ated with suicidal ideal ion among the elderly (W ^ bilildinn , i '•"»m ium -ises J T he resolutions of earlier ptfd**£ requred 0rlearthatin '«« ^, the courage and e*g be le v , ,niU,,n flexible and adaptive to «e ^ 1^" t^nVhe ^" ^'cgo rescues establ-^^ source ism" S°me of the very old, this pi«*»* nf nJS".0^*"^ they face the end of life in i the pt passivity and doubt further reflection; Explain what is ,11t'a"'(^ll a if chosocia! concepl of immortality. Analyze ways ^^ď^ social support system contributes to the reso j immortality versus extinction. „ufií1" . is - a sh'",1S i?nc' Evaluate the notion that spirituality becomes ? gVl well-being in Icier life. Why might (his be true-(here lo support (his Idea? . ,, nfže to Speculate about how positive resolutions oj tri ^to^ ^ liviiy versus stagnation and integrity versus "^^^0^ the resolution <>| the crisis of Immortality vc',sl Meeting the Needs of the Frail Elderly 599 applied topic Meeting the Needs of the FraW Elderly OBJECTIVE 6. Apply research and theory to concerns about meeting the needs of the frail elderly. older adults to remain in their homes as long as possible. The council provides suggestions to individuals about how to modify their homes to make them accessible and how to lake advantage of community resources and services. It also sponsors innovative collaboration between health care, transportation, and corporate interests to create products and services that will facilitate optimal residential communities for the very old (National Aging in Place Council, 2013). he ff'al of providing services or community resources to Ule frail elderly should be to enhance a realistic level ol Performance. On the one hand, one should not try to en-C0«rage 80-year-olds to live the lives of teenagers or people **r 50s. On the other hand, one should not ho Id such ^,ni"ial expectations for the elderly that they are robbed ol lheir autonomy and ability to meet challenges or to striv .t0^rd achievable goals. One of the current issues that has be_C0n* a locus of research and policy debate is the extent to physical frailty in elderhood is treatable or prevent-9ble and how to reduce dependency, especially in long-term ,n 2004, the U.S. Administration on Aging announced ^Uiative locused on supporting "Seniors Aging in ■** - ......."ini»> to the Defining Frailty seniors "o ° n„ an initiative locused on su^ — g preference; fageinplace.org) in response to tne ive projed the very old to remain bdepende*^ ^ u, cl v, c 'unded that provided new n*oU ^ a vV t in the community so that older ^ ,cvel ol id of needs and abilities could retain ano Id retain an ^lplaCe CoUnc -• "«uí ano aoiuLicr. ^..... , Aoulg 111 i- and ls a forum whose mission is to vV(,rK toge corporations in specific co*»u*W^ ^ NV,„ permit Provide the system ofcommunit) Frailty has typically been operai ional.zed in terms ol dependency. One common approach is to list any difficulties in the ADLs, including bathing, dressing, transferring from the bed to a chair, using the toilet, and eating. Sometimes, these assessments include walking a short distance because this degree of motor ability is usually required to function independently Beyond these basic types of sell-care, an expanded notion of dependency refers to difficulties in managing instrumental activities of daily living (IADLs), such as shopping, preparing meals, doing light housework, using transportation, or using the telephone. These tasks, though clearly more complex than the basic ADLs, are essential to maintaining one's daily life without dependence on informal or formal community support services (Figure 14.16). Dependency or difficulty in managing ADLs increases markedly alter age iS1). Many factors combine to produce this dependency. In most postindustrial societies, later adulthood is characterized by a sedentary lifestyle. Estimates suggest thai only about 10% ol older adults are active enough f|gure u.16 Because of his Pr°blems walking, Caleb was Practically homebound. But once hls children bought him this mo-tor'2ed chair he was able to enjoy Soing outdoors, interacting with ne'ghbors, and taking Pebbles for awalk.What other technological Mentions help support optimal fU|tctioning in elderhood? 600 j chapter 14 Elderhood (75 Until Death) to sustain appropriate levels of muscle strength and cardiovascular capacity. Weakness resulting from disuse combines with certain biological changes, diseases, medications, and malnutrition to produce muscle atrophy, risk of falling, reduced arousal and cognitive capacity, and a gradual decline in confidence in being able to cope with even moderate types of physical exertion. Measures of functional limitations often fail to differentiate between what people say they might be able to do in a hypothetical context (when completing a survey) and what they actually do in their day-to-day lives. For example, some people may respond to a questionnaire saying thai they are able to walk half a mile without help, but they do not actually ever walk that much. Others may respond that they cannot walk half a mile without help, but in fact they walk several blocks on most clays to go to the store near their home. When observed in their natural setting, many older adults use compensatory strategies to overcome some physical impairment or integrate the support of others so they can enact certain functions even though they have serious disabilities. For example, in a sample of women who needed assistance in more than three areas of daily living, more than one fourth still managed to gel lo church services once a week or more. They did not allow their physical limitations lo reslricl iheir role involvement (Glass, 1998; Hayward & Krause, 2013). for many older adults, problems with remaining indepen-dent change from time to lime. In the winter, when streets are icy and the weather is cold, a person may need more help because it is difficult to walk outside or lo wait lor the bus. In the event of an acute illness requiring a period of hospitalization, a person may temporarily need support during the poslhospi-tal recovery bill does not require long-term institutionalization. Full recovery from a week or two of being bedridden may require additional physical therapy, rebuilding muscle lone and endurance and rebuilding confidence in managing daily tasks. The outcome lor the older person depends on the patient, caregiver, and health care system—all sharing expectations lor recovery and rehabilitation rather than viewing the person as permanently weakened ami destined lor prolonged dependency 0 ) S. Department ol l lealth and I luman Services, 2013). Supporting Optimal Functioning Optimal functioning is what a person is capable of doing when motivated and well prepared, lo support optimal functioning ol elderly people, one must accurately assess their limitations. One docs not want to lake away the supports dial help very old adults sustain their independence or over-react to their physical or intellectual limitations. This tendency, however, is observed in ike responses of some adult children to their aging parents. Once the children realize lhat their parents are not functioning at the same high level of competence that they enjoyed previously, the children move toward a role reversal. The children may inlanlilize or dominate their parents, insisting on taking over all financial mailers or attempting lo relocate their parents toaI*! n ^e tective housing arrangement. Gradually, some c iieeumu. i w -.......i I (inane __se the importance ol healtn^^ ial considerations lor their parents and to 0^ compan- adult en n rlool away all their parents' decision-making responsibilities. Although children mav view such actions as being"1 'heir parents' best interests, they may fail to take their parents' preferences into account. For example, children tend to overemphasize cii significance of familiar housing in preserv unship and daily support that are critical to their parents 982). Adult children mayfs0 i... and re- f their y structur ~* ^ sense of well-being (Kahana, I9u^,. >~— . allC fail to realize how important decision-making <- ^ sponsibility lor personal care arc lo the maintcna In mutually satisfying jondups between adult daughters and their aging mothers. he daughters made sure that their mothers were consistently 2, dedsions ** ^ected thetr lives, even when the mothers were heavily dependent on their daughters for 4& ^ (Pratt, Jones, Shin, & Walker, J 989). In ma"V nursing homes, there is a similar tendency to «iuce or eliminate expectations of autonomy by (ailing^ 8 ye residents responsibilities for planning or performing W ^vmes of daily hie. Routine ^ „ cooking, cleaning, shopping lor groceries, doing laundry, planning n^' ' answering the phone, paying bills, and writing letters" give older adults the sense that life is going along as us" facing these responsibilities with unstructured m "d(!vS"bjeclvcry«W people to more itress than conf^ ^expect some forms of regular contribution to daily I*-bihTipc W°rk ^gnments and structured daily re*** 1 - arc activities that an institutional setting can p*** 'm'n,a",ahlRhbd of sodaland intellectual^ an em! " residents- The Eden Alternative (2009)* den^f ^ TCCpl in l,ul-'« home care that gives re* dents responsibilities for some f spect of their environ*** - - tenons*1'1 depending on their level of functioning lies—such as watering plants, volunteering m care center, or reading lo other residents ' - ., the negative impact of dependency and institute ^c0- etivim ,se respe-chllcl i*'"' r0llic elderly has ■ .^PP^ing the optimal functioning of.. the nhl ' comPetencies and limitations, hot so a vvheehl m"« For example, older adults who a How^ef tnn316 ''^^ 10 exPertence a fall every so oW home m T Wh° have installed modifications * ' , easy!Zd g widened doorwavs «*> halls- railingvh i- horI h1( °0,rarc less finely to fall than those h3Ve ^t been modified (Berg, Hines, & Allen. 2^ ithout fear of falling, ^ di. these In'"1'' A person who cannot wa or grasp objects because of arthritis may nee (ications in the home thai will compensate Id lions. Many creative strategies have been tíítr0' permit people with serious physical disability optimal level of autonomy in their homes. , -rdi118' Meeting the Needs of the Frail Elderly | 601 The Role of the community Mosl older adults want to remain in their community as un8 as possible. Interventions at the community level may °e necessary to meet their safety, health, and social needs. l0Usjng, transportation, and health care resources and ser-V'Ces are essential elements of a community response. States Jat '"vest in these resources are able to reduce the growth in tlle c°sts of long-term care expenses for elders (U.S. Department of Health and Human Services, 2013). . 11 is important for resources to be accessible. In promol-lnS optimal functioning in urban settings, lor example, it is 'mPWUnt to provide health care settings that are more easily ^■ssible for elderly people with limited mobility. Andrul.s ;20°0) has taken this point of view one step further by argu-y**t as the number of elderly people in the urban centers °' lhe united States increases, health care organizations and providers supported by local, state, and federal governments be Prepared to reach out to the growing population ol People. Many of these people are poor, have physt-'aI •imitations, and experience psychological barriers such as npCl^ived threat of violence, confusion, fear, and embamss-*et" over lack of financial resources. As a result, they may * Ullable or unwilling lo leave then immediate enviion-meni- Community outreach would have to provide a wide sVarie/y of services to a culturally diverse population with Pecial attention to poverty-related concerns. . community resources that have been found to be use u io > as ihey strive to remain in their communities mc udc du ^'ng: transportation resources, educational oppoi umnes centers, Volunteer opportunities, food and ma Jjyon, housing and home modification services. ,.- home J** care and services, and the creation ol «**»g 2f* elders can interact. Information and referral se v us io > and their caregivers provide access to a c verse , ay J0""* as needs arl anc! change. Many P^-J^ ^grams and services for which they are ehgpblc -^ledgeable people are about commumty resou cc 5**. the longer 'hey are likely to expect to remain living UePendently in their home (Tang& Lee, 2011) °n» »>•.......>- -r.......,m,mitv response to um Prove Pr°8ran1C,(|!S'° resources is lbc "Red TaPe L-Lu^ efils f0r at lmproves access to over 40 services and ben-^len tL s- The person completes just one application. l,on ailcje Cnic'ago Department of Aging reviews the applica-3ric' Pro ^ lne Person a printout of the services, henelns (\'ng sgrams for which they are eligible and how to apply i « ei'vices Council of Central Texas, 2013). -...,.,/ services for e cfl of Central Texas. orelders js de. A unique set of coordinated servi _ T)u, project as Project Care, in San Diego, C >°rts fraii older aduks in living independently anc 8Secure. This program has several components. * Po**l Alert: Postal came,, air trained to keep a watchful !* on older residents, [f mail is not collected b°^, carriers will check on residents and report problem. j Daily Calls: Computer generated phone calls at a time selected by the client. If call is not answered, volunteers make follow up calls. • Gatekeeper: Utility workers and sanitation engineers keep an eye on older adults by recognizing signs of trouble such as uncollected newspapers or garbage not set out on collection clay. Concerns are forwarded to proper agency. • Health Care Info: Older adults receive a medical information box that affixes to refrigerator. Box contains medical history info, medication records and other health related data. The information is used by paramedics responding to emergencies in a clients home. • Home Repairs: Volunteers and local businesses help make minor home repairs that support health and safety. • Safe Return: A national program of the Alzheimer's Association, Safe Returns, helps local authorities locate, identify and return home individuals with dementia. In a surprising essay, Clive Thompson (2007) wrote about the features of life in New York City that contribute to longevity A major theme was the role of walking and climbing stairs as aspects of daily life in the city. "Driving in the city is maddening, pushing us onto the sidewalks and up and down the stairs to the subways. What's more, our social contract dictates that you should move your ass when you're on the sidewalk so as not to annoy your fellow walkers" (p. 31). living in areas that are densely populated means access to more markets, specialty shops, and interesting things to do in walking distance. People in New York City arc more likely to walk a mile to get io something, than people who live in suburban or rural areas. In a shift from earlier views of cities as crime-ridden, disease-promoting, alienating environments, some social scientists are starting to write about urban health advantages. Friendship groups arc likely to form in neighborhoods; big cities may have bigger, more fully equipped hospitals; and population density can an rail more parks, gyms, and recreational facilities. The causal relationship between urban life and health is probably bidirectional. As cities become safer, people wilh more resources (who generally have greater longevity) want to live there, attracting more of the lifestyle resources that support health (figure 14.17). Urban areas arc likely to be comprised ol "naturally occurring retirement communities" (NORCs), places where over 50% of the residents are over age 60, Communities where people of shared interests and needs live near one another allow community members to voice their collective needs and concerns in order to influence the distribution or creation ol appropriate resources. At the same time, a community with a certain density ol elders provides an efficient approach for locating services that will meel the needs of the residents. For some elderly adults, the absence of meaningful interpersonal relationships is the greatest barrier to optimal functioning. The role of the informal social support system in meeting the needs of the frail elderly cannot be 602 j chapter 14 tlderhood (75 Until Death] underestimated. Children, spouses, other relatives, and neighbors are all important sources ol help. Within communities, the elderly are themselves likely to provide signilicant help to age-mates who may be ill, bereaved, or impaired in some way Most older adults prefer not to have to ask for help. I towever, they are much better off if they have someone to turn to than if they have no one. Beyond personal networks of social support, communities have been characterized by different levels of collective efficacy which combines a strong sense of social cohesion with a high level ol inlormal social control (Sampson, Raudenbush, & Earls, L997). People who live in communities characterized by high collective eilicaey are willing to take on important community concerns and to intervene on each others behalf even il they do not know one another on a personal level. Examples of the impact of collective efficacy include reducing violent victimization, child or elder abuse, and illicit drug trafficking in a neighborhood. ( bmmunities that are high in collective efficacy will act to draw on the required resources to attract health care services, create new recreational settings, and improve transportation resources. In all these ways, communities characterized by i olleclive efficai y can enhance the health and optimal functioning ol the frail elderly (Browning & Cagney, 2003). The Role of Creative Action ;^;ľ-;:d';:ll:;'l''''''>-nselvest,, promote al„l =■ By identifying meaningful goals and coordi tiling to achieve these goals, older ľduhs^n 7Z v ^ thai are both meaningful and manageably "r f ''^ * BaUcs, 2005). Very old adults L figure 14.17 Many communities are sensitive to the need for informal recreational resources for elderly residents. Bocce Ball is a favorite pastime where friends gather to socialize, gel a bit of exercise, and engage in henó y competition. their environment to preserve optimal functioni ^ggt nance their sense of well-being. They may move t ^ ^Qlt climate, to a homogeneous-age community, o ^£j]tf\ce modest home or apartment that entails fewer ^ 1 cjaSSe5 01 responsibilities. They may participate in exe'a^.ength> &y other guided physical activity to improve the11 ^ an" durance, and flexibility. Elders may select some ^pgCL friendship relationships that they sustain lhr^j[ieS, Th^ interaction, mutual help giving, and shared acti jnClud' may participate in activities in community setti g^ ^ ing churches, senior centers, libraries, and voU^rpOSe &° nizations through which they retain a sense o 1 .^^st oO social connection. They may decide to locus the jnjng 9 a single role that is most important to them- jlJeS a"1' sense of control over important life roles and^ac gl(jer5 tributes to longevity and well-being. As at earlier g^ ?{[y make certain choices that direct the course ol lh^.a|| ]evel 0 vide a sense of meaning, and influence their ove adjustment (Figure 14.18). elcierly K In summary, the quality of life for the hail ^gO' pends on lour factors: (1) the specific nature an (2)lhC the health-related limitations that accompany affj£ ^0 availability of appropriate resources within the h° ^e th^ and community to help compensate lor or ttiin 0giV« limitations; (3) the selective emphasis that the p to some life experiences over others as being cen ^ ct,ir being; and (4) the person's motivational oriental tinue to find creative strategies to adapt to change-FURTHER REFLECTION: Explain the concept of op^]dK mg. Based on what you have read about die develop™^ f> and psychosocial crisis of elderhood, what suggest make for enhancing the care of the frail elderly? Chapter Summary 603 figure u.18 At age 85, George Preserves his playful outlook by spending time with his great-granddaughter. They take turns surprising each other with new costumes, songs, and games. 0 /5 CHAPTER SUIVI^^ ip for identifying -I* OBJECTIVE 1. Explain the rational ^ e elderhood as a unique develoPme^loprnental tasks of unusual longevity with its o ahd psychosocial crisis. ^ opp0rtuni- «* that will be Led by an old and old** years ahead. Those who are 80 popl nno, ^ fastest growing «gP«J^ of one's death, * ^ preached a sense of acceptan ^ bonUS yea ^ 10 find meaning and enjoyment ing physi cognitive capacities, a deepen a peopic . Place of ones life in the hi*orjd£ t0 the ingness to and new and fl*^ ^ ong0mg ^1 °f daily life. This period of in* lcVMopmcm ^-organization. . „ nSYchosocial g In attempting to describethe ^^b£^ the very old, we are drawn WC ^ haVe >* a) non-Western philosophical u rspective,e gs such concepts as P"**0*^ social ^PP0-J ive on lranscendencc, immortality analong_range PersP 'hat reflect the need to assume . li'c and its meaning. 2 List the physical changes associated °BJE nd Pva uate the challenges that these f daily life for the very old is innuenced to quality o) dai yl e health. For some, daily ^ eXlCn;.X edbyone or more chrome disease, activities are restrict y (0 hve Ul SS^SSHp^...........■>■""■* independently «.t.vf i Describe the concept of an altered .or continued well-being 604 j chapter 14 klderhood (75 Until Death) An increasingly wide range ol lifestyle alternatives are being invented in elderhood, including opportunities For travel, housing that provides varying levels of care, and patterns ol close relationships in which traditional gender roles are modified to take into consideration new capacities and interests. objective 5. Define and explain the psychosocial crisis of immortality versus extinction, the central process of social support, the prime adaptive ego quality of confidence, and the core pathology of diffidence. Having lived well beyond their li fe expectancy, elders lace the psychosocial crisis ol immortality versus extinction. A key to their quality of life lies in whether they are integrated into effective social support networks. Social support provides help, resources, meaningful social interaction, and a psychological sense ol being valued. Elders who survive within a support system can transcend the limitations of their mortality, finding comfort and continuity in their participation in a chain ol loving relationships. Those who are isolated, however, are more likely to face the end ol their lives bound to the tedium of struggling with their physical limitations and resenting their survival •»j> objective 6. Apply research and theory to about meeting the needs of the frail elderly concerns the re'; The topic of the care of the frail elderly illustrates . . .. i ti. resource3 rt opü«*1 evance of a psychosocial framework. The iesü^ services available in the community can sUPP°u^_ farnily functioning. Children, grandchildren, and °j el>jragjng members need to he able to interpret the needs ol 1 ^ce. parents without underestimating their capacity 01 1 ^ by Finally, older adults can guide the direction ol Witt ^ ^ the decisions they make, both in earlier periods 0 they delect new signs of frailty. KEY TERMS active engagement, 582 activities of daily living (ADLs), 578 affiliative values, 589 behavioral slowing, 574 collective efficacy, 602 community-based long-term health care, 587 confidence, 598 continuing care retirement community, 586 cosmic transcendence, 594 dependency, 590 diffidence, 598 experiential iranscendence, 593 extinction, 594 fitness, 572 frailty, 599 functional independence, 577 gender gap, 570 gender-role convergence, 589 gentrili cation, 588 housing options, 586 immortality, 592 instrumental activities of daily living (IADLs), 599 instrumental support, 595 instrumental values, 589 life structure, 571 living arrangements, 584 norm ol reciprocity, 596 nursing home, 586 old-old, 571 optimal functioning, 600 organic brain syndromes, 578 physical changes of aging, 5 /1 processing load, 574 psychohistorical perspective, 578 role reversal, 600 sexuality, 590 skill care facility, 586 social support, 595 socioemotional support, 595 successful agers, 582 usual aging, 582 visual adaptation, 575 young-old, 571 CASEBOOK For additional cases related in this chapter, see "Still Going Sirou;',," in Life Span Development: A Case Book, by Barbara and Philip Newman, Laura Landry-Meyer, and Brenda J. Lohman, pp. 215-218. This case highlights the ' f.,na of living arrangements lor the health and wcll-bc"* live 93-year-old woman.